Markku Tuominen

Injuries in men's international ice hockey: a 7-year study of the International Ice Hockey Federation Adult World Championship Tournaments and Olympic Winter Games

Background Information on ice hockey injuries at the international level is very limited. The aim of the study was to analyse the incidence, type, mechanism and severity of ice hockey injuries in mens international ice hockey tournaments. Methods All the injuries in mens International Ice Hockey Federation World Championship tournaments over a 7-year period were analysed using a strict definition of injury, standardised reporting strategies and an injury diagnosis made by a team physician. Results 528 injuries were recorded in games resulting in an injury rate of 14.2 per 1000 player-games (52.1/1000 player-game hours). Additionally, 27 injuries occurred during practice. For WC A-pool Tournaments and Olympic Winter Games (OWG) the injury rate was 16.3/1000 player-games (59.6/1000 player-game hours). Body checking, and stick and puck contact caused 60.7% of the injuries. The most common types of injuries were lacerations, sprains, contusions and fractures. A laceration was the most common facial injury and was typically caused by a stick. The knee was the most frequently injured part of the lower body and the shoulder was the most common site of an upper body injury. Arenas with flexible boards and glass reduced the risk of injury by 29% (IRR 0.71, (95% CI 0.56 to 0.91)). Conclusions The incidence of injury during international ice hockey competition is relatively high. Arena characteristics, such as flexible boards and glass, appeared to reduce the risk of injury.

Sport concussion assessment tool - 3rd edition - normative reference values for professional ice hockey players

OBJECTIVES To determine normative reference values for the Sport Concussion Assessment Tool-3rd Edition (SCAT3) using a large sample of professional male ice hockey players. DESIGN A descriptive cross-sectional study. METHODS Preseason baseline testing was administered individually to 304 professional male ice hockey players. RESULTS The participants were aged between 16 and 40 with a mean (M) age of 25.3 years. Over 60% of the athletes reported previous concussion, almost 20% had been hospitalized or medically imaged following a head trauma. Of the players, 48% reported no symptoms. The symptom score median (Md) was 1.0 (M=1.5) and severity median was 1.0 (M=2.3). The median of the SAC score was 27.0 (M=27.0). The median of the M-BESS was 1.0 (M=2.0). The Tandem gait median was 10.9s (M=10.8s). The most common baseline symptom was neck pain (24%). Delayed recall was the most difficult component of the SAC (Md=4); only 24% performed it flawlessly. All athletes completed the double-leg stance of the M-BESS without errors, but there was performance variability in the tandem stance (Md=0, M=0.6, range=0-10) and single-leg stance (Md=1.0, M=1.4, range=0-10). CONCLUSIONS Representative normative reference values for the SCAT3 among professional male ice hockey players are provided.

Injuries in women's international ice hockey: an 8-year study of the World Championship tournaments and Olympic Winter Games

Background We report the incidence, type, mechanism and severity of ice hockey injuries in womens international ice hockey championships. Methods All injuries in the International Ice Hockey Federation World Womens Championship, World Womens under-18 Championship and Olympic Winter Games tournaments were analysed over an 8-year period using a strict injury definition, standardised reporting and team physician diagnosis. Results 168 injuries were recorded in 637 games over an 8-year period resulting in an injury rate (IR) of 6.4 per 1000 player-games and 22.0/1000 player-game hours. The IRs were 2.7/1000 player-games for the lower body, 1.4 for the upper body, 1.3 for the head and face and 0.9 for the spine and trunk. Contusion was the most common injury followed by a sprain. The most commonly injured site was the knee (48.6% of lower body injuries; IR 1.3/1000 player-games). The Medial collateral ligament sprain occurred in 37.1% and ACL rupture in 11.4% of knee injuries. A concussion (74.3%; IR 1.0/1000 player-games) was the most common head injury. Conclusions and recommendations The risk of injury to female ice hockey players at World Championship and Olympic tournaments was about half of that observed in the mens Championships. Full facial protection decreases the risk of lacerations and should be continued in all future female tournaments. More effective prevention strategies for knee, ankle and shoulder injuries are needed in womens ice hockey. Improved concussion education is necessary to promote more consistent diagnosis and return to play protocols.

Injuries in world junior ice hockey championships between 2006 and 2015

Background Detailed injury data are not available for international ice hockey tournaments played by junior athletes. We report the incidence, type, mechanism and severity of injuries in males under ages 18 and 20 at junior ice hockey World Championships during 2006–2015. Methods All injuries in the International Ice Hockey Federation World Junior under-20 (WJ U20) Championship and under-18 (WJ U18) Championship were collected over a 9-year period using a strict injury definition, a standardised injury reporting system and diagnoses made by a team physician. Results 633 injuries were recorded in 1326 games over a 9-year period, resulting in an injury rate (IR) of 11.0 per 1000 player-games and 39.8/1000 player-game hours. The IRs in all tournaments were 4.3/1000 player-games for the head and face, 3.2 for the upper body, 2.6 for the lower body and 1.0 for the spine and trunk. A laceration was the most common injury type followed by a sprain. Lacerations accounted for 80% (IR 3.6) of facial injuries in WJ U20 tournaments. The shoulder was the most common injury site (IR 2.0) in WJ U18 tournaments. Board contact was the mechanism for 59% of these shoulder injuries. Concussion was the most common head and face injury (46%; IR 1.2) in WJ U18 tournaments. Conclusions and recommendations The risk of injury among male junior ice hockey players was lower than the reported rates in adult men but higher than that in women. Facial lacerations were common in U20 junior players (WJ U20) since most wear only partial facial protection (visor). The IR for shoulder injuries was high in U18 junior players (WJ U18). Suggested strategies for injury prevention include full facial protection for all players and flexible board and glass for all junior tournaments.

Interpreting change on the SCAT3 in professional ice hockey players

OBJECTIVES To examine test-retest reliability of the SCAT3 for two consecutive seasons using a large sample of professional male ice hockey players, and to make recommendations for interpreting change on the test. DESIGN A cross-sectional descriptive study. METHODS Preseason baseline testing was administered in the beginning of the seasons 2013-2014 and 2014-2015 to 179 professional male hockey players in rink side settings. RESULTS The test-retest reliabilities of the SCAT3 components were uniformly low. However, the majority of athletes remained grossly within their own individual performance range when two pre-season SCAT3 baseline scores were compared to published normative reference values. Being tested by the same person or a different person did not influence the results. It was uncommon for the Symptom score to worsen by ≥3 points, the Symptom Severity score to worsen by ≥5 points, SAC total score to worsen by ≥3 points, M-BESS total error points to increase by ≥3, or the time to complete Tandem Gait to increase by ≥4s; each occurred in less than 10% of the sample. CONCLUSIONS The SCAT3 has low test-retest reliability. Change scores should be interpreted with caution, and more research is needed to determine the clinical usefulness of the SCAT3 for diagnosing concussion and monitoring recovery. Careful examination of the natural distributions of difference scores provides clinicians with useful information on how to interpret change on the test.

Concussion in the international ice hockey World Championships and Olympic Winter Games between 2006 and 2015.

Background Concussions in sports are a growing concern. This study describes the incidence, injury characteristics and time trends of concussions in international ice hockey. Methods All concussions in the International Ice Hockey Federation (IIHF) World Championships (WC) and Olympic Winter Games were analysed over 9 ice hockey seasons between 2006 and 2015 using a standardised injury reporting system and diagnoses made by the team physicians. Results A total of 3293 games were played (169 tournaments, 1212 teams, 26 130 players) comprising 142 244 athletic game exposures. The average injury rate (IR) for concussion was 1.1 per 1000 ice hockey player-games for all IIHF WC tournaments. The IR was the highest in the mens WC A-pool tournaments and Olympic Games (IR 1.6). However, the annual IR for concussion in the mens tournaments has been lower than that in the World Junior tournaments since 2012. When a concussion occurred with contact to a flexible board, the IR was 0.2 per 1000 player games. In contrast, the IR was 1.1, if the board and glass were traditional (for the latter, RR 6.44 (95% CI 1.50 to 27.61)). In the mens tournaments, the trend of concussions caused by illegal hits decreased over the study period. After the 4th Consensus Statement on Concussion in Sport was published (2013), none of the concussed players in the mens WC returned to play on the day of injury. Conclusions The annual risk of concussion in the mens WC has decreased during the study period. This was most likely due to a reduction in illegal hits. The risk of concussion was significantly lower if games were played on rinks with flexible boards and glass. Rink modifications, improved education and strict rule enforcement should be considered by policymakers in international ice hockey.

Sport Concussion Assessment Tool: Interpreting day-of-injury scores in professional ice hockey players

OBJECTIVES To characterize the clinical utility of Sport Concussion Assessment Tool 3 (SCAT3) baseline and normative reference values for the assessment of acute concussion; and to identify the sensitivity of each SCAT3 subcomponent to the acute effects of concussion. DESIGN Prospective cohort. METHODS The day-of-concussion SCAT3 results (n=27) of professional male ice hockey players (mean age=27, SD=4) were compared to athletes individual baseline and to the leagues normative reference values. Normative cutoffs corresponding to 10th percentile and natural distribution change cutoffs corresponding to 90th percentile cumulative frequency were considered uncommon. RESULTS The percentages of the players with uncommon day-of-injury performance, when post-injury scores were compared to individual baseline versus (vs.) normative values, were as follows: symptoms: 96% vs. 100% (post-injury score: M=12, Md=12, SD=4; severity M=26, Md=23, SD=13); Standardized Assessment of Concussion (SAC): 33% vs. 27% (post-injury M=25, Md=26, SD=3); modified-BESS (M-BESS): 46% vs. 46% (post-injury M=7, Md=5, SD=7); Tandem Gait: 18% vs. 31% (post-injury M=11, Md=12, SD=4); coordination: both 8%. The number and severity of post-injury symptoms were significantly greater, with extremely large effect sizes (Cohens d=2.44-3.92), than normative values and individual baseline scores. The post-injury SAC score was significantly lower relative to both baseline (d=0.68) and normative values (d=0.88). The post-injury M-BESS performance was significantly worse when compared to both individual baseline (d=1.06) and league normative values (d=1.46). No significant day-of-injury Tandem Gait deficits were observed using either comparison method. CONCLUSIONS SCAT3 league normative values were as sensitive as individual baseline scores during day-of-injury assessments. Symptoms were the most sensitive post-concussion component of the SCAT3.

Concussions in international ice hockey championships and olympic winter games between 2006 and 2015

Objective To describe the occurrence and trend of concussions during the international ice hockey tournaments. Design Register study. Setting The International Ice Hockey Federation (IIHF) World Championships and Olympic Winter Games. Participants A total of 3293 games were played in the 169 tournaments by 1212 teams (26130 players) comprising 142244 athletic game exposures. Outcome measures One hundred and sixty concussions were observed. Main Results The average injury rate (IR) for concussion was 1.1 per 1000 ice hockey player-games for all IIHF World Championship tournaments (WC). The injury rate was highest in mens WC A-pool tournaments and Olympic Winter Games (OWG) (IR 1.6), and lowest in womens WC and OWG (IR 0.9). However, the annual injury rate for concussion in mens tournament has been lower than that in World Junior tournaments since 2012. When concussion occurred in a contact with a flexible board injury rate was 0.2 per 1,000 player games and 1.1 if a board and glass were traditional [RR 6.4, (95% CI 1.50–27.61]. In mens tournaments the trend of concussions caused by illegal hits decreased over a study period. After the 2012 Zurich Consensus Guidelines none of the concussed players returned to a play during a same day in mens WC tournaments. Conclusions The risk of concussion was significantly lower if games were played on rinks with flexible board and glass. Between 2006 and 2015, the annual risk of concussion in mens WC has been decreasing most likely due to the decreasing number of concussions caused by illegal hits.