Football and ice hockey are both contact sports where people collide with certain amounts of force. Beyond that there are many differences. Football is generally played on turf where there is some give when a player hits the ground. Once in a while it will be played on artificial turf but that happens less and less often. Ice hockey is played on ice and we all know there is no give in ice. When an ice hockey player is nailed with a hard check and falls to the ice there will be a greater chance of injury, especially to their head and especially to children.

In November of 2010 a new study on Canadian junior ice hockey uncovered frightening head injury/concussion data and trends. This report asks many questions about the safety and well being of teenagers and young adults who participate in ice hockey. This report triggered a series of companion articles discussing return-to-play issues, the importance of increasing concussion awareness through education, and social/cultural behaviors.

The cumulative and long-lasting effects of sports concussions have been the subject of studies and Congressional hearings in the U.S. It is now understood that in Canada, ice hockey is a major cause of sports-related concussion. Here is a comment from Dr. Paul Sean Echlin, one of the authors of a study that is the basis for this report, “The aftermath of a concussion can impact memory, judgment, social conduct, reflexes, speech, balance and coordination. Epidemiological studies have suggested an association between sport concussions and both immediate and later-life cognitive impairment. As such, this is a public health issue that needs to be taken more seriously by players, parents, coaches, and medical professionals.”

Here is information culled directly from the study.

This is the first study to document the incidence of concussion in junior hockey players based on the 2009 Zurich consensus statement on concussions from the 3rd International Conference on Concussion in Sport. The Hockey Concussion Education Project (HCEP), a prospective cohort study was conducted during one junior hockey regular season (2009-2010) with 67 male ice-hockey players, ages 16-21 from two fourth-tier teams. Prior to the start of the season, players underwent baseline assessments using the Sideline Concussion Assessment Test (SCAT2) and the Immediate Post-Concussion Assessment and Cognitive Test (ImPACT).

  • Concussion surveillance was done at each regular season game of the participating teams by one independent physician and one to three independent, non-physician observers. Among the key study findings:
  • Seventeen players suffered a total of 21 concussions during the 52 physician-observed games.
  • Twenty-nine percent (5/17) of the HCEP players suffered a second or recurrent concussion during the study period.
  • Eighty-eight percent (15/17) of the players with a diagnosed concussion admitted to having suffered at least one concussion in the past. Two of the seventeen players who suffered a concussion during the study admitted that they had concealed a concussion sustained during the current season in order to keep playing.
  • The forward position suffered 71 percent of the concussions; defensemen 29 percent; and no concussions were incurred by goalies.
  • Fifty-seven percent of diagnosed concussions occurred in the third period, 29 percent in the second period, and 14 percent in the first period.
  • Twenty-four percent (5/21) of the HCEP concussions occurred in players who were directly involved in a fight immediately prior to their diagnosis.
  • The mean clinical return-to-play duration in 15 players was 12.8 days.
  • Players in the education intervention groups demonstrated a positive trend toward concussion knowledge retention compared to the control group.

The bottom line is in the ice hockey culture there is a reluctance among players to report symptoms of a concussion even when they understand what the symptoms are. The situation is made worse by parents and coaches who will not reinforce concussion education.

One unfortunate proof of the study is a series of suicides among former NHL “Enforcers.” When autopsies were preformed all showed damage to the brain consistent  with multiple incidents of head trauma and concussion. Enforcers might be on the extreme end of the curve but they are far from alone and the damage can start early.

How do we stop this epidemic?

One step has been taken by USA Hockey, the governing body of youth ice hockey in the United States. Beginning with the 2011-12 season, the age for legal body checking has been raised to the Bantam level (ages 13-14) from the Pee-Wee level (ages 11-12). Also beginning in the upcoming season is a rule that prohibits any check to the head or neck.

The National Hockey League (NHL) has introduced a Player Safety channel on the NHL Videocenter. This webpage contains a collection of videos showcasing safe and legal hits in the game of ice hockey.

Many ice hockey leagues (including the NHL) require players to undergo a baseline neurocognitive test. Baseline neurocognitive tests assess a healthy person’s decision making ability, reaction time, memory, and attention. The test results are then used after a concussion is sustained to help a physician or other qualified medical professional determine if the athlete’s brain has returned to its pre-concussion level of function.

How Can You Protect the Player?

You can continue educating players, parents and coaches. A more immediate step is for players, parents and coaches to learn the signs of a concussion and to pay attention to them:

What are the symptoms of a concussion?

The easiest way to show you is to show you. The Children’s Hospital of Philadelphia has created an outstanding infographic for the symptoms of a concussion. CHOP encourages others to embed this infographic on their site or in a post. Please click the “Concussion Symptoms” tab at the top of the page. After you look at the infographic please return to the top of the page and click the “Keith Primeau Video” tab to watch his outstanding video on concussions.

The following Infographic was created by the Children’s Hospital of Philadelphia


Click to get this infographic from the Children’s Hospital of Philadelphia website. Please return to the top of the page and click the “Keith Primeau Video” tab to watch his outstanding video on concussions.

Watch this video on concussion awareness produced by Keith Primeau, former NHL player with the Detroit Red Wings and the Philadelphia Flyers: