Rules on contact, equipment, testing can address concussions in ice hockey

Key takeaways:

• In the NHL, concussions suffered in the last 2 decades led to significant missed playing time.
• Rules prohibiting body checking in youth players were most effective for preventing concussion.

Concussions suffered in hockey led to substantial missed playing time, while their physical effects require leagues of all ages to bolster rules, utilize protective equipment and implement high-quality injury protocols to address the issue.

“The incidence of concussion in hockey is concerning, given the immediate pain, discomfort and cognitive difficulties and association with long-term cognitive deficits and mental health problems especially in individuals who have sustained multiple concussions,” Nathan A. Shlobin, MD, MBA, of the Northwestern University Feinberg School of Medicine during the study, and colleagues wrote in Neurosurgical Focus.

Shlobin and colleagues sought to examine the landscape of concussion in ice hockey as well as to clarify any catalyzing initiatives to standardize preventative concussion mechanisms and return-to-play (RTP) considerations.

Their mixed-methods study encompassed five parts: analysis of the impact of concussions on games missed and income for National Hockey League (NHL) players using a publicly available database with statistics from 2000 through 2024, systematic reviews of concussion incidence in ice hockey, preventive strategies for concussion and RTP, along with a policy review of documents from major governing bodies related to concussions in sports with a focus on ice hockey.

Researchers utilized PubMed, Embase and Scopus databases for this purpose.

In the NHL, a total of 1,054 concussions were recorded among 689 players during the search parameters, leading to a mean of 13.77±19.23 games missed during the same season. The incidence of concussions was 0.54 to 1.18 per 1,000 athlete exposures.

The researchers further reported that concussion prevention mechanisms involved education, behavioral and cognitive interventions, protective equipment, biomechanical studies and policy/rule changes. Rules prohibiting body checking in youth players were most effective. Determination of RTP for those who suffered concussion was variable based on location; protocols from both North American governing bodies and two leagues mandated that a player suspected of having a concussion be removed from play and undergo a six-step RTP strategy, while the 6th International Conference on Concussion in Sport recommended mouthguards for children and adolescents and to disallow body checking for all children and most levels of adolescents.

“We strongly encourage hockey leagues to adopt and adhere to age-appropriate rules that limit hits to the head, increase compliance in wearing protective equipment and utilize high-quality concussion protocols,” Shlobin and colleagues wrote.