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PEDIATRICS Vol. 105 No. 3 March 2000, pp. 657-658
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ABSTRACT |
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Abstract
Conclusion
Recommendation
References
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Ice hockey is a sport enjoyed by many young people. The occurrence of injury can offset what may otherwise be a positive experience. A high proportion of injuries in hockey appear to result from intentional body contact or the practice of checking. The American Academy of Pediatrics recommends limiting checking in hockey players 15 years of age and younger as a means to reduce injuries. Strategies such as the fair play concept can also help decrease injuries that result from penalties or unnecessary contact.
Ice hockey is played by approximately 200 000 children in
the United States1 and a similar number in Canada. It is classified as a collision sport by the American Academy of Pediatrics because of the intentional body contact, called body checking, that
occurs. Because collisions in this sport may occur at high speeds,
participants are at risk for serious injury. In recent years, an
increase in the number of serious head and neck injuries related to
body checking has alarmed the hockey community and has led to a
reassessment of the role of body checking in the various
classifications of youth hockey2-4: mite In the 1960s, an alarming number of facial injuries in youth hockey
players led to the mandatory use of helmets with a face mask.5 The acceptance and use of the combination
helmet-face mask was remarkably successful in virtually eliminating
facial trauma. However, shortly after the introduction of the
helmet-face mask, an increase in the number of neck and spinal
injuries was noted.4 The improvement in equipment with the
helmet-face mask1,6 was believed to create a false sense of protection from serious injury. A similar situation was observed in
football. With additional protection afforded by improved helmets and
face masks in the 1950s, there was an increase in cervical spine
injuries. The number of spinal injuries did not start decreasing until
rule changes in the 1970s prohibited head-first contact. Rule changes
instituted in the mid-1970s substantially decreased, but did not
eliminate, these tragic injuries. The ice hockey community wanted to
learn from the experience in football and avoid a paradoxical increase
in injury as a response to wearing protective equipment. This concern
led to investigations of the incidence and causes of head, neck, and
spine injuries.7-9
A Canadian study in 19842 revealed 42 spinal injuries in
hockey players reported to the Committee on Prevention of Spinal
Injuries. The median age of the injured players was 17 years. Of the 42 players, 28 had spinal cord injuries, of which 17 had complete paralysis below the vertebral level of the injury. Being body checked
from behind, resulting in a collision with the boards, was the most
common mechanism of injury. A 1987 study7 of high school
hockey players revealed that head and neck injuries accounted for 22%
of the total number of injuries. The same study showed that body
checking was associated with 38% of the total number of injuries.
Sixty-six percent of the players surveyed believed that the requirement
of a face mask allowed them to be more aggressive in their style of
play. The authors of this study recommended rule changes to limit or
eliminate body checking to reduce injuries.
A more recent US study reported injuries in youth hockey players 9 to
15 years old.1 Head and neck injuries accounted for 23%
of the total number of injuries. Body checking accounted for 86% of
all injuries that occurred during games. Fifty-five percent of the
players thought that their helmets and face masks protected them from
injuries. Of particular interest is that size differences among players
in this series increased with age, with bantam-level players (ages 14 and 15 years) showing the most variation, with reported differences
between the smallest and largest players of 53 kg in body weight and 55 cm in height. The bantam-level players sustained the most injuries
(54%).
Another Canadian study10 compared peewee-level players
(ages 12 and 13 years) from a league that allowed body checking with
another league that did not. Players in the league that allowed body
checking had a fracture rate 12 times higher than the rate of the other
league. Body checking in combination with substantial differences in
size and strength among players was believed to contribute to the high
injury rate, with some players being nearly twice as heavy and twice as
strong as other players. Players in the same age group could vary
significantly in the amount of force they could impart on another
player and/or withstand from another player. In 1990, the Canadian
Academy of Sports Medicine reported that although the incidence of
serious injuries at the mite and squirt level was quite low, serious
injuries were noted at the peewee level. Therefore, they recommended
banning body checking at the peewee level (ages 12 and 13 years) and
below.11
An innovative, unique concept for improved sportsmanship and injury
reduction in youth hockey called fair-play has been introduced recently.12 The fair-play concept of scoring ice hockey games, seasons, or tournaments was developed in response to the perceived increase in violence in youth hockey. The system rewards teams and individual players with few penalties and punishes teams and
players with larger numbers of penalties. The authors of this concept
believe that the system decreases penalties, intimidation, and violence
during hockey and creates a climate that promotes fun and player
development.
The potential benefits for the fair-play concept are demonstrated in a
recent study13 involving a youth hockey tournament. The
participants were high school students younger than 20 years old, who
played the qualifying rounds of the tournament using fair-play
guidelines (points are awarded for playing without excessive penalties)
and the championship round following regular rules. When the fair-play
and regular rules portions of the tournament were compared, the injury
rate was 4 times higher during the regular rules portion of the
tournament. A doubling of the number of penalties and injury rate
during the championship round occurred when fair-play rules were
suspended.
Studies have shown that a high proportion of youth hockey injuries
are attributable to checking and that limiting checking can reduce
injuries. Disparities in size and strength can further increase the
risk for serious injury from checking and other collisions. Variations
in size and strength are present in all age groups but are most
pronounced among the bantam-level players (ages 14 to 15 years).
Therefore, minimizing checking and other high-impact collisions in this
age group could further reduce injuries.
In the interest of enhancing safety in youth ice hockey, the
American Academy of Pediatrics recommends the following.
ages 8 and 9 years; squirtages 10 and 11 years; peeweeages 12 and 13 years; and
bantamages 14 and 15 years.
CONCLUSION
Top
Abstract
Conclusion
Recommendation
References
RECOMMENDATIONS
Top
Abstract
Conclusion
Recommendation
References
COMMITTEE ON SPORTS MEDICINE & FITNESS, 1999-2000
Steven J. Anderson, MD, Chairperson
Bernard A. Griesemer, MD
Miriam D. Johnson, MD
Thomas J. Martin, MD
Larry G. McLain, MD
Thomas W. Rowland, MD
Eric Small, MD
LIAISON REPRESENTATIVES
Claire LeBlanc, MD
Canadian Pediatric Society
Carl Krein, AT, PT
National Athletic Trainers Association
Robert Malina, PhD
Institute for the Study of Youth Sports
Judith C. Young, PhD
National Association for Sport & Physical Education
SECTION LIAISONS
Frederick E. Reed, MD
Section on Orthopaedics
Reginald L. Washington, MD
Section on Cardiology
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FOOTNOTES |
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The recommendations in this statement do not indicate an exclusive course of treatment or serve as a standard of medical care. Variations, taking into account individual circumstances, may be appropriate.
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REFERENCES |
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Abstract
Conclusion
Recommendation
References
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Statement of reaffirmation:
This article has been cited by other articles:
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H. G. Gardner and and the Committee on Injury, Violence, and Poison Office-Based Counseling for Unintentional Injury Prevention Pediatrics, January 1, 2007; 119(1): 202 - 206. [Abstract] [Full Text] [PDF]
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A. Macpherson, L. Rothman, and A. Howard Body-Checking Rules and Childhood Injuries in Ice Hockey Pediatrics, February 1, 2006; 117(2): e143 - e147. [Abstract] [Full Text] [PDF]
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D. Luke Characteristics of Ice Hockey-Related Injuries Treated in US Emergency Departments, 2001-2002 Pediatrics, May 1, 2005; 115(5): 1448 - 1449. [Full Text] [PDF]
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 K. N. Waninger Management of the Helmeted Athlete With Suspected Cervical Spine Injury Am. J. Sports Med., July 1, 2004; 32(5): 1331 - 1350. [Abstract] [Full Text] [PDF]
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I. B. Ross Bodychecking in hockey Can. Med. Assoc. J., January 6, 2004; 170(1): 15 - 15. [Full Text] [PDF]
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