Allowing body checking in youth hockey may increase risk of injury, including severe concussions

"Ice hockey is a popular North American winter sport, with more than 550,000 registered youth players in Hockey Canada and more than 340,000 registered players in the USA Hockey Association in 2008-2009. Despite the advantages of sport participation, there is increasing concern regarding the frequency of ice hockey injuries in youth," the authors write. They add that recent attention has been focused on the increased frequency of concussive head injuries in youth hockey. It is the most common type of specific injury, accounting for more than 15 percent of all injuries in 9- to 16-year-old players, according to background information in the article.

Internationally, there are different regulations regarding the age at which body checking is introduced in ice hockey. In the United States, body checking is introduced in all leagues for the age group 11-12 years, but leagues not permitting body checking exist through all ages, up to the leagues for 15-16 year-olds. In Canada, the youngest age group in which body checking is permitted is Pee Wee (ages 11-12 years). In the province of Quebec, however, Bantam (ages 13-14 years) is the youngest age group in which body checking is permitted.

Carolyn A. Emery, Ph.D., B.Sc.P.T., of the University of Calgary, Alberta, Canada, and colleagues examined whether the risk of concussion and injury differed for youth ice hockey players in a league that permits body checking vs. a league that does not. The study was conducted in Alberta and Quebec during the 2007-2008 Pee Wee ice hockey season and included players (n = 2,154) from teams in the top 60 percent of divisions of play. Among the outcomes measured was the rate for game- and practice-related injuries and concussions.

Seventy-four Pee Wee teams from Alberta (n = 1,108 players) and 76 Pee Wee teams from Quebec (n = 1,046 players) completed the study. There were a total of 241 injuries (78 concussions) reported in Alberta and 91 injuries (23 concussions) reported in Quebec. For game-related injuries, the Alberta vs. Quebec incidence rate ratio (comparison of the risk of injury in the two leagues) was 3.26 (n = 209 and n = 70 for Alberta and Quebec, respectively]) for all injuries; 3.88 (n = 73 and n = 20) for concussion; 3.30 (n = 51 and n = 16) for severe injury (time loss, greater than 7 days); and 3.61 (n = 14 and n = 4) for severe concussion (time loss, greater than 10 days).

"The estimated absolute risk reduction (injuries per 1,000 player-hours) that would be achieved if body checking were not permitted in Alberta was 2.84 for all game-related injuries, 0.72 for severe injuries, 1.08 for concussion, and 0.20 for severe concussion. There was no difference between provinces for practice-related injuries," the authors write.

"Among 11- to 12-year-old ice hockey players, playing in a league in which body checking is permitted compared with a league in which body checking is not permitted was associated with a 3-fold increased risk of all game-related injuries, concussion, severe injury, and severe concussion. These findings may have important implications for policy decisions related to body checking in youth ice hockey. The public health implications associated with injury in Pee Wee hockey in which body checking is permitted are significant."

"Future research should compare the injury and concussion risk in the next age group of play (Bantam, ages 13-14 years), in which players in one cohort will have 2 years of body checking experience prior to Bantam participation. This research can inform the development and rigorous evaluation of prevention strategies to reduce the risk of injury in this population of youth ice hockey participants," the authors conclude.