A systematic video analysis of National Hockey League (NHL) concussions, part II: how concussions occur in the NHL
Hutchinson MG., Comper P., Meeuwisse WH., Echemendia RJ. British Journal of Sports Medicine. 2013; ahead of print.
Take Home Message: The predominate mechanisms of concussions in the NHL are player to opponent contact. This is usually directed to the lateral aspect of the head by the shoulder, elbow, or glove. Players that sustain a concussion typically do not have the puck and often a penalty was not called on the play.
Across all levels of play and age groups within ice hockey, concussions are one of the most common injuries that athletes suffer. Little is known about the exact mechanisms of how concussions occur in ice hockey. Establishing the most common mechanisms of how ice hockey players receive concussions will increase concussion awareness and education as well as assist medical professionals to detect potential concussive events. Therefore, the purposes of this study was to describe how concussions occur in the NHL as well as identify the association of concussion injuries with puck possession and penalties given at the time of concussive injury. Two raters individually viewed digital video records of physician-diagnosed concussions from the NHL injury surveillance system from over a 3.5-year period during the 2006-2010 seasons. The raters coded the digital video records of concussions using the Heads Up Checklist, which provided a standardized framework for coding injury mechanisms of concussion. The Heads Up Checklist contained 17 specific factors organized into 3 broad sections: event, game situation, and equipment. A total of 260 concussions occurred in the 4299 NHL regular season games of which 197 were identified on video and analyzed in the study. Eighty-eight percent of the concussive events were associated with player-to-player contact. Approximately 35% (71/197) of all concussions during the 3.5 seasons were classified as a direction contact to the lateral aspect of the head by shoulders, elbows, or gloves. Sixteen out of the 197 concussive events were due to fighting. During these 16 events the player experienced a direct blow to the head by fist or by striking the ice surface. Concussions not caused by fighting resulted mostly from direct contact from the shoulder (55%), elbow (21%), or gloves (12%). The most common body part initially contacted was the head (68%) followed by torso (28%). The most common location of the initial contact to the head was laterally (47%) followed by anteriorly (18%) and posteriorly (3%). The most common initial contact to the torso was posteriorly (13%) followed by laterally (11%) and anteriorly (3%). When considering concussive events (excluding fighting), 23% of concussed players had possession of the puck, 34% had no possession of the puck, and 42% of players just released the puck. Of the events evaluated there was sufficient information to determine whether a penalty was called for 168 events. Of these 49 events were considered penalties and 37 were deemed rule violations but the officials gave no penalty.
Within the time period October 2006 to December 2009 most of the concussions suffered were characterized by player-to-player contact. These contacts were most often characterized by a hit to the lateral aspect of the head by the opposing players’ shoulders, elbows, or gloves when the injured player was not in possession of the puck. Furthermore, the officials often did not call a penalty on the play. The finding of a clear mechanism that warranted a penalty when no penalty was given provides evidence for including a rule-based approach to reduce the occurrence of concussive events. Medical professionals should be cognizant of the predominant mechanisms associated with concussions in NHL as well as educate athletes about the common mechanisms of concussive events. Similar to this study a video analysis within a high school lacrosse population found that most concussions occurred by a direct hit to the athlete’s head (79%), while the athlete was not in possession of the ball (59%), and a penalty was rarely called on the play (26%). Therefore, these three findings may apply to different sports and skill levels.
Questions for Discussion: Do you think a rule change would help decrease the occurrence of concussions within the NHL? If fighting was not allowed in the NHL do you think less people would be interested in watching the sport?
Written by: Jane McDevitt PhD, ATC, CSCS
Reviewed by: Jeffrey Driban