By Dev K. Mishra, M.D.
President, Sideline Sports Doc
Clinical Assistant Professor of Orthopedic Surgery, Stanford University
January 21, 2020
- Some of the most effective injury risk reduction strategies in sports involve changes to rules and equipment
- Tactics used by USA Hockey including recommendations for full facial protection, technical changes in player body positioning during contact, and eliminating body checking until age 13 have proven to result in injury risk reduction
- USA Hockey’s Chief Medical Officer Dr. Michael Stuart notes that: “Injury prevention requires a multifactorial approach including education, coaching, rule enforcement, rule modifications, equipment improvement, sportsmanship and mutual respect.”
In collision-based sports such as hockey and tackle football, modifications to rules and equipment are effective ways to reduce injury risk. The authors of a recently published clinical review state that “Preventative measures, such as mandatory facial protection and delayed body checking in games until age 13 years, are proven strategies to reduce the risk of facial injury and concussion.”
While that article is specific to the sport of hockey, many of the principles advocated by the authors could easily be applied to other sports. Multiple aspects of sport safety would include quality education for coaches, parents, and athletes; updated coaching techniques, improved protective equipment, enforcement of existing rules, and elimination of dangerous activities (head hits, checking from behind, etc.).
Many of the advocated tactics are based upon common sense, however, prospective studies are now starting to show that these efforts lead directly to a reduction in injury risk and injury rates.
Injury Rates Increase From Younger To Older Players
Similar to other sports, the hockey players showed that injury rates were lower for the youngest players and increased with each level of competition. “Youth, high school, junior, college, and professional hockey players have unique injury patterns. Injuries occur much more often in a game compared with a practice, and injury risk increases with each level of competition.”
For the youngest players, the majority of injuries involved sprains, strains, and contusions.
By contrast the most common types of injury in professional players were lacerations, ligament sprains, contusions, and fractures.Lacerations are most common in the head and neck region because players wear only partial facial protection (visor). Injuries occur much more frequently during games than in practices.
The rate and type of injuries found offer opportunities to intervene and make positive impacts in injury risk reduction.
Prevention Strategies Are Effective
Under the leadership of Dr. Michael Stuart, chief of sports medicine at the Mayo Clinic and chief medical officer for USA hockey, a number of implemented changes are proving a cause and effect relationship to injury risk reduction. Dr. Stuart noted to me that “Injury prevention requires a multifactorial approach including education, coaching, rule enforcement, rule modifications, equipment improvement, sportsmanship and mutual respect.”
Full facial protection eliminates eye injuries and greatly decreases head and face injuries. No facial protection is associated with a two times increased risk of facial injury compared to partial protection and an almost seven times increased risk compared to full protection.
USA Hockey has enacted the “Heads Up, Don’t Duck” initiative to decrease the frequency of cervical spine and spinal cord injuries. Players are taught to make contact with the boards with any body part except the head. As a result of strong education about proper contact technique there’s been a substantial reduction in the number of catastrophic spine injuries in hockey.
Finally with respect to concussion prevention,USA Hockey took important measures including teaching body checking skills in practice, delaying body checking in games until age 13 years, and penalizing both intentional and unintentional hits to the head.
I applaud Dr. Stuart and the directors of USA Hockey for taking bold steps that were I’m sure going counter to long-established hockey practice and traditions. What we’re starting to see now is that these steps are making the sport safer for all participants, and that’s tough to argue against.