Study shows significant decline in hockey-related spinal injuries

The past decade has seen a significant reduction in the number and severity of spinal cord injuries in Canadian ice hockey, reports a study in the Clinical Journal of Sport Medicine. The journal is published by Lippincott Williams & Wilkins, a part of Wolters Kluwer Health, a leading provider of information and business intelligence for students, professionals, and institutions in medicine, nursing, allied health, and pharmacy.

"[The] recent decline in spinal injuries in Canadian ice hockey…may be related to improved education about injury prevention and/or specific rules against checking/pushing from behind," concludes the new study, led by Dr. Charles H. Tator of Toronto Western Hospital.

Decreases in Overall and Serious Spinal Injuries
The researchers analyzed data from the ThinkFirst Canadian Ice Hockey Spinal Injuries Registry. The goal was to provide updated data on the rates of and risk factors for hockey-related spinal cord injuries in Canada, including games, practices, and unorganized play.

Forty cases of spinal injury occurred in Canadian hockey players from 2000 to 2005: an average of 6.7 injuries per year. This represented about a 50 percent decrease in the rate of spinal cord injuries, compared to the 1980s and 1990s. There was also a marked decline in spinal injuries among juvenile hockey players—the age group at highest risk.

Severe spinal cord injuries also decreased: 12.5 percent of injuries occurring from 2001 to 2005 were rated severe, compared to 23.5 percent in previous years. However, hockey-related spinal injuries still had serious consequences. The researchers estimated that nearly half of all injuries recorded in the registry caused permanent neurological damage, and that one-third of the injured players will be in a wheelchair for life.

New Rules on Checking and Safety Programs Credited
Sixty-five percent of injuries in the registry involved impact with the boards. Thirty-five percent were caused by checking/pushing from behind—but this was less common in more recent years. The ThinkFirst registry was started in 1981, in response to a sharp rise in spinal cord injuries in Canadian hockey. Previous studies using registry data identified checking/pushing from behind into the boards as the most common cause of spinal cord injury.

In response, specific rules against checking from behind were introduced. Dr. Tator and colleagues believe this rule, and its consistent enforcement, has been a key contributor to the reduction in spinal cord injuries. Injury prevention efforts like ThinkFirst's Smart Hockey: More Safety More Fun! program have also been popular and successful. (Find information on Smart Hockey at the ThinkFirst website, http://www.thinkfirst.ca/programs/smart_hockey.aspx.)

Increases in aggression, player size, and speed are also risk factors for spinal cord injuries. Dr. Tator and colleagues believe that the use of protective equipment, such as helmets and face shields, gives players a feeling on invincibility. As a result, players may play more aggressively and with a lack of respect for their own and opponents' bodies. The researchers also believe that different coaching cultures may contribute to regional variations in spinal injury rates—highest in Ontario, British Columbia, New Brunswick, and Prince Edward Island and lowest in Quebec and Newfoundland. "The coach is considered to be the most important individual for maintaining safety on ice," Dr, Tator and co-authors write.

Despite some data limitations, the updated report suggests substantial progress toward reducing the rate and severity of spinal cord injuries in Canadian ice hockey. "It is highly likely that the identification of risk factors followed by the development and dissemination of targeted injury prevention programs have contributed to the reduction," Dr. Tator and co-authors conclude. They hope the new findings will contribute to further reductions in these potentially devastating injuries.