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Clinical Sciences: Clinically Relevant

Comparison of injury patterns in elite hockey players using ice versus in-line skates

HUTCHINSON, MARK R.; MILHOUSE, CRAIG; GAPSKI, MICHAEL

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Medicine& Science in Sports & Exercise: September 1998 - Volume 30 - Issue 9 - p 1371-1373
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Abstract

As the popularity and use of in-line skates has grown, so has the sport of hockey on in-line skates. More than 12 million Americans have taken up the sport of in-line skating, accounting for some 76,000 emergency visits and 346 million dollars of medical bills annually (1). Nearly 20% of the participants also participate in hockey on in-line skates.

Ice hockey is commonly recognized as a relatively high risk sport and has a risk of 16.9 game-related, time-loss injuries per 1000 athletic exposures (Table 1)(8). Various authors have presented the variation of injury patterns regarding anatomic distribution, mechanism of injury, and injury type seen in ice hockey (2,3,5,6,9,10,12-14). According to NCAA Surveillance regarding collegiate ice hockey (8), 31% of injuries are to the upper extremity with half of those to the shoulder, and 33% of injuries are to the lower extremity with nearly half of those to the knee. Indeed, according to the NCAA, contusions are by far the most common type of injury (23%) followed by ligament sprains(20%), muscle-tendon strains (15%), dislocations and separations (11%), fractures(8%), concussions (6%), and others.

TABLE 1
TABLE 1:
Game injury rate summary (all sports)

Although there are numerous articles regarding injuries or risks associated with in-line skating (4,7,11,15), no comparative studies have shown the variations in injury patterns in similar populations of athletes participating in hockey on in-line versus ice skates. Therefore, the purpose of this study was to perform injury surveillance on professional hockey players whose prime variable was their type of skate.

MATERIALS AND METHODS

During the 1993-1994 seasons, injury surveillance was undertaken on two professional roller hockey teams (Chicago Cheetahs and the Anaheim Bullfrogs, Roller Hockey International, Inc.) and one professional ice hockey team (Chicago Blackhawks, Chicago Blackhawks Hockey Team, Inc.). One roller hockey team was able to provide two seasons of data, while the other two teams provided a single season's injury reports. All injury reports were taken at the time of injury and recorded by a certified athletic trainer. Injury data collected included player and team identification, mechanism of injury, anatomic location, type of injury, specific diagnosis, treatment, and follow-up. All injuries included were new game-related injuries. Injuries were defined as those that required evaluation or assistance from the medical team. Additional documentation included which injuries required time loss from the sport of more than one practice or game.

RESULTS

For the ice hockey athletes, 67 injuries were recorded over 97 games (Table 2). Twenty-one injuries were severe enough to require some time loss from sport; the average was 8.3 d per injury. For the hockey players on in-line skates, 75 injuries were recorded over 108 games. Twenty-five injuries required a time-loss from sport averaging 6.5 d.

TABLE 2
TABLE 2:
Injury data.

Anatomic region of injury, types of injuries, and mechanism of injury were converted to percentages in each sport for visual comparison (Table 3, Table 4, Table 5, respectively). Statistical analysis was performed using a student t-test with P > 0.05 defined as significant. Significant differences are marked on the tables.

TABLE 3
TABLE 3:
Types of injury.
TABLE 4
TABLE 4:
Mechanism of injury.
TABLE 5
TABLE 5:
Anatomic region of injury.

DISCUSSION

As the popularity and use of in-line skates has grown so has the sport of ice-hockey on in-line skates. Ice hockey is recognized as a sport with an increased risk of both number and severity of injuries; however, little information is available on hockey on in-line skates. This paper shows that hockey has a similar overall injury risk on ice skates (119 injuries per 1000 AE) or on in-line skates (139 injuries per 1000 AE). Even when time-loss injuries alone are considered, the injury risk is comparable between the hockey on in-line skates (46 injuries per 1000 AE) and on ice skates (36 injuries per 1000 AE).

While overall there is no significant difference in the risk in participating in either sport, subtle variations do exist between the two. Lacerations occur more frequently in ice hockey (32% of all injuries) than in roller hockey (24% of all injuries); however, this may not be solely associated with the skate wear. Rules regarding slashing, fighting, and high sticking are stricter and more likely to be enforced in professional roller hockey. This may provide a deterrent to these "at-risk" activities. The absence of blades in roller hockey has reduced the incidence of some skate related injuries(16% of injuries in ice hockey related to skate, 7% of roller hockey injuries related to skate) and lacerations secondary to a skate are entirely obviated in roller hockey.

Other factors may also affect the injury variations between the two sports. Fewer players are on the playing surface at any given time in professional roller hockey (five in roller hockey; six in ice hockey). The beaded puck used in roller hockey does not move as quickly over the playing surface as a standard puck moves over ice. One could hypothesize an increase in puck related injuries in ice hockey secondary to the increased kinetic energy of the puck; however, only a small nonsignificant increase is seen (16% of all injuries in ice hockey, 11% of all injuries in roller hockey.)

The in-line skate also requires a change in some skating techniques that may be associated with minor variations in injury patterns in the two sports. Even though in-line skaters can achieve and maintain speeds of 25 to 30 mph, these speeds are less than are possible on ice skates. One could hypothesize that the increased kinetic energy would be associated with an increase in severity of injuries in ice hockey. Indeed a trend was seen with the average time loss from sport being 8.3 d for ice hockey and 6.5 d for hockey on in-line skates; however, this was not statistically significant and additional data are needed to see whether the trend is maintained. The slower moving roller hockey athlete may also be an easier target for checking than a fast moving ice hockey player. Indeed, checking is a more common mechanism of injury in roller hockey (48%) than in ice hockey (23%).

Another variation in technique is seen when the athlete is required to change directions or quickly stop. Ice hockey players can stop short and quickly go the opposite way by cutting their blade into the ice. This is not possible on in-line skates and most players instead roll through their turns. However, this variation in technique does not appear to be associated with a reduction in ankle injuries in roller hockey (5% of all injuries) compared with those in ice hockey(1% of all injuries).

CONCLUSION

Certain injuries such as skate lacerations are eliminated by the use of in-line skates. Nonetheless, the overall injury patterns in hockey with regard to mechanism, anatomic location, or injury type appear to be similar regardless of the type of skate used. Subtle differences may be explained by rules variations between the sports or by the differences in speed of both the puck and athlete in the two sports. By far the most common injuries in both sports are facial lacerations because at the professional level the athletes are not required to wear face protection.

REFERENCES

1. American Academy of Orthopaedic Surgeons Bulletin. Injuries From In-Line Skating. Rosemont, IL: AAOS, April 1995, pp. 8-9.
2.Biasca, N., H. P. Sieman, A. R. Bartolozzi, and O. Trentz. Review of typical ice hockey injuries: Survey of the North American NHL and Hockey Canada versus the European Leagues. Unfallchirurg 98:283-288, 1995.
3.Daly, P. J., F. H. Sim, and W. T. Simonet. Ice hockey injuries: a review. Sports Med. 10:122-131, 1990.
4. Goh, S. G., H. K. Tan, and L. B. Y. Yong. Spectrum of rollerblading injuries. Ann. Acad. Med. (Singapore) 25:547-549, 1996.
5. Jorgensen, U. and S. Schmidt-Olsen. The epidemiology of ice hockey injuries. Br. J. Sports Med. 20:7-9, 1986.
6. Laprade, R. F., Q. M. Burnett, R. Zarzour, and R. Moss. The effect of the mandatory use of face masks on facial lacerations and head and neck injuries in ice hockey: a prospective study. Am. J. Sports Med. 23:773-775, 1995.
7. Mitts, K. G. and W. L. Hennrikus. In-line skating fractures in children. Pediatr. Orthop. 16:640-643, 1996.
8. National Collegiate Athletic Association. Game injury rate summary (all sports). In: 1996-1997 NCAA Sports Medicine Handbook. Overland Park, KA: NCAA, 1997, p. 71.
9. Petterson, M. and R. Lorentzen. Ice hockey injuries: A 4-year prospective study of a Swedish elite ice hockey team. Br. J. Sports Med. 27:251-254, 1993.
10. Roberts, W. O., J. D. Brust, B. Leonard, and B. R. Herbert. Fair-play rules and injury reduction in ice hockey. Arch. Pediatr. Adolesc. Med. 150:140-145, 1996.
11. Scheiber, R. A., C. M. Branche-Dorsey, G. W. Ryan, G. W. Rutherford, et al Risk factors for injuries from in-line skating and the effectiveness of safety gear. N. Engl. J. Med. 335:1630-1635.
12. Simonet, W. T. and L. Sim. Boot top tendon lacerations in ice hockey. J. Trauma 38:30-31, 1995.
13. Stuart, M. J. and A. Smith. Injuries in junior A ice hockey a 3-year prospective study. Am. J. Sports Med. 23:458-461, 1995.
14. Williams-Avery, R. M. and D. P. Mackinnon. Injuries and use of protective equipment among college in-line skaters. Accid. Anal. Prev. 28:779-784.
15.Reference not provided.
Keywords:

ICE HOCKEY; IN-LINE SKATES; INJURY PATTERNS; ELITE ATHLETES

©1998The American College of Sports Medicine