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Eighty-six male high school ice hockey players were studied to determine both the incidence of injury in high school ice hockey and the influence of physical, situational, and psychosocial factors. Physical factors include height, weight, vision, previous injuries, musculoskeletal abnormalities, and injuries present at the time of evaluations. Situational factors examined were level of participation, playing time, player position, and games vs. practices. Psychosocial factors such as confidence, stress, social support, positive states of mind, and mood states were also examined. Twenty-seven injuries occurred during the 1994-1995 season. Overall incidence of injury in high school hockey games (34.4 per 1000 player-game hours) was less than the incidence of injury in Junior A hockey (96.1 per 1000 player-game hours) and was more than previously reported for Bantam youth hockey (10.9 per 1000 player-game hours). Injuries occurred more often in games than in practices, usually as a result of collisions. Physical factors such as player position and previous injuries did not significantly predict injuries, but players in the high playing time group were more likely to be injured. Psychosocial factors of low vigor and high fatigue significantly predicted high school ice hockey injuries.
Smith and associates from the Mayo Clinic Sports Medicine Center described preseason perceived fatigue, game time participation and playing time as predictors of injury in high school ice hockey players.
They also reported collisions, as opposed to stick or puck contact, as the most frequent cause of injury for high school players. The wide distribution in the types and site of injury, preseason injuries, and physical factors noted on written exam were not significant predictors of injury.
The most important conclusion of this study was to reaffirm the change in injury patterns in hockey since the mandatory use of the face mask. Before, facial, dental, and eye injuries were the most significant (i.e., lacerations or fractures of teeth). The higher incidence of collisions than expected may represent the level of skill in high school league. The importance of psychosocial factors is interesting and obviously should be considered a factor in injury. The multiple variables associated with fatigue and the use of an assessment, which is unpublished, brings the reliability of this finding into some question. Nonetheless, other studies have indicated that psychosocial factors play a role in injury and should be considered.
Studies such as this are important because, by understanding injury distribution and causative variables, interventions for prevention can be implemented. As Smith et al indicate, instruction, equipment modification, and rule changes have an effect on the number of collision injuries. Such interventional studies should be undertaken to determine if injury rates can be reduced. (Dr. Goldberg is Director of Sports Medicine, Yale University School of Medicine.)