A systematic video
analysis of National Hockey League (NHL) concussions, part II: how concussions
occur in the NHL

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.

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.

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?

by: Jane McDevitt PhD, ATC, CSCS


Hutchison MG, Comper P, Meeuwisse WH, & Echemendia RJ (2013). A systematic video analysis of National Hockey League (NHL) concussions, part II: how concussions occur in the NHL. British journal of sports medicine PMID: 23637116