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Abstract
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Since many professional ice hockey players suffered career changing concussions, including Eric Lindros of the Philadelphia Flyers in 1998 and Sidney Crosby of the Pittsburgh penguins in 2011, the issue of concussion has been brought to the forefront in Canadian youth ice hockey. Recognized as Canada's national winter sport, ice hockey is played across the country with more than half-a-million youth and young adults registered annually.1 Unfortunately ice hockey has 1 of the highest sport-related injury burdens leaving numerous youth players suffering from injuries including concussion with the possibility of long-term consequences.2 In 2011, in an attempt to mitigate the high ‘concussion burden’ across youth leagues, Hockey Canada implemented the national “zero tolerance for head contact” policy.3 This policy mandated, at every level of the sport, the penalization of any player-to-player head contact.3 This change notwithstanding, the concussion burden remains high. In particular, the rate remained unchanged in youth leagues that permitted body checking with reported rates of 3.3 to 4.2 concussions/1000 game-hours.2,4,5 How can we mitigate this burden?
In ice hockey, several mechanisms of injury can lead to concussion.3,6 Direct impact to the head by another player is 1 of the primary concussive mechanisms.3,6 Krolikowski and colleagues3 first evaluated the “zero tolerance for head contact” policy by comparing the change in concussion rates across the U13 (11–12-year-old, formerly Pee Wee) and U15 (13–14-year-old, formerly Bantam) playing levels. This retrospective cohort study found an increase in the rate of concussion across both levels after the “zero tolerance for head contact” policy implementation, with the primary mechanism of concussion being body checking and direct head contact. The authors cited increased concussion awareness and education after the policy change as factors that may have led to the higher concussion rates reported after this “zero tolerance” policy change. Using a prospective video-analysis cohort study, we revealed that the incidence rates of direct player-to-player head contacts did not differ pre-to-post “zero tolerance” policy implementation, validating the view that the policy did not lead to lower concussion rates.7 Furthermore, almost 10 years postpolicy implementation, we added an additional cohort to evaluate whether additional implementation time and policy amendments (increasing the severity of penalties assessed for direct head contact) had altered the rates of head contact.8 Although we found a 25% to 30% lower direct head contact rate in U15 elite games (with body checking permitted), more than 10 direct head contacts still occurred every game, leaving numerous players at risk for concussion.8 What was also revealed was that only 16% of head contacts resulted in a penalty in gameplay.8 Ironically, 84% of direct player-to-player head contacts did not result in a penalty, despite the “zero tolerance” policy.8 The research surrounding the “zero tolerance for head contact” policy has revealed that although a policy has been implemented, additional emphasis and effort need to be expended to help mitigate the concussion burden across youth ice hockey ...
Language: en |