SPRINGFIELD COLLEGE LIBRARY MANUSCRIPT THESIS The manuscript copies of master’s theses and doctoral dissertations deposited in the Library of Springfield College are available for appropriate usage. If passages are copied, proper credit must be given to the author in any written or published work. Extensive copying or publication of materials should be done only with the con¬ sent of the Director of the School of Graduate Studies. This thesis or dissertation by has been used accordingly by the persons listed below. (Librarians are asked to secure the signature of each user.) Name and Address College Date SPRINGFIELD COLLEGE SCHOOL OF GRADUATE STUDIES December 1997 We Recommend that the thesis prepared under our direction by . George E. Bullock, Jr., ATC entitled ICE HOCKEY INJURIES: A COMPARATIVE STUDY OF INCIDENCE AND SEVERITY be accepted as fulfilling the research requirement for the degree of Master of Science Annrnved hv: ICE HOCKEY INJURIES: A COMPARATIVE STUDY OF INCIDENCE AND SEVERITY A Thesis Presented to the Faculty of Springfield College In Partial Fulfillment of the Requirements for the Degree Master of Science by George E. Bullock, Jr., ATC December 1997 IX DEDICATION This body of work is dedicated to my Grandmother Anna Wingate, "Because tomorrow is another day." (h> cn -a top .3 Ill ACKNOWLEDGEMENTS I would like to express my gratitude to the members of my research committee, Mr. Charles Redmond, chair¬ person, Dr. Mary Ann Coughlin, and Prof. Robert Bergquist, without whom I would have not been able to successfully complete my master's thesis and graduate experience. I would like to extend thanks to all the graduate students in the Sport Injury Prevention and Management Master's program, especially Joseph A. Ferraro, ATC, without whom, we would have most certainly all gone insane. I would also like to thank the Springfield Falcons and Indians Professional Hockey Organizations, especially Webb Sommer, ATC, Stu Lempke, ATC, and Ralph Calvanese. These special people helped pave the road to my professional career. I thank all the trainers that participated in the study, because without them, it would not have been possible. A final word of gratitude goes to my Mom and Dad, and the rest of my family and friends, who suffered through two more years of my absence and infrequent phone calls. December 1997 G.E.B. Jr. iv Table of Contents Page List of Tables . vii List of Figures. ix Abstract 2 Introduction 3 Method 8 Subjects 9 Development of Questionnaire 10 Design and Procedures 11 Institutional Permission 11 Informed Consent 12 Statistical Analysis 13 Results 18 Descriptive Statistics 18 One-way Chi Square Analysis 20 Two-way Chi Square Analysis 25 Discussion 27 References 37 Appendix A. RESEARCH DESIGN .... 44 Statement of the Problem 44 Definition of Terms 45 Delimitations 48 V Page Appendix A. RESEARCH DESIGN (continued) Limitations 50 Hypotheses 51 Appendix B. REVIEW OF LITERATURE 53 Epidemiology of Ice Hockey Injuries 54 Increasing Player Velocities and Puck Velocities 56 The Hockey Stick as a Source of Potential Injury 58 Off-season and Pre-season Conditioning Programs 59 Player Specialization as an Injury Potential 62 Protective Equipment Discrepancies 64 Classification of Injuries 67 Measurement Reporting Forms .68 General Definitions of Classifications of Injuries 73 Reporting Inconsistencies 75 Incidence and Severity of Ice Hockey Injuries 81 Effects of Visor Use on Head Injury Reduction 84 Summary 86 Appendix C. INJURY SURVEY FORM 90 Appendix D. DIRECTIONS TO COMPLETING INJURY SURVEY FORM 92 VI Page Appendix E. LETTER TO ATHLETIC TRAINERS 96 Appendix F. INFORMED CONSENT 98 Appendix G. CHI SQUARE ANALYSIS TABLES 100 Appendix H. ADDITIONAL TABLES 109 Appendix I. RAW DATA TABLES 115 BIBLIOGRAPHY 121 Vll List of Tables Table Page 1. Data Showing Number of Institutions, Athletes, Return and Injury Rates, and Number and Percent of Major Injury Sites for Division I, Division II/III, and High School (N = 14) 41 2. Chi Square Analysis for Injury Location . 99 3 . Chi Square Analysis for Injury Type 102 4. Chi Square Analysis for Injury Cause .... 103 5. 3x3 Chi Square Analysis Comparing Player Position and Division I, Division II/III and the High School Division 104 6. 3x3 Chi Square Analysis Comparing Level of Injury Severity and Division I, Division II/III and the High School Division .... 105 7. 3x3 Chi Square Analysis Comparing Time of Injury Occurence and Division I, Division II/III and the High School Division 106 8. 2x3 Chi Square Analysis Comparing Time of Injury Occurence, Game Versus Practice, for Division I, Division II/III, and the High School Division 107 9. Data Comparing Player Injury Pecentage Rates Among Research Literature 108 10. Data Comparing the Percentage of Injuries Incurred to Specific Anatomical Sites Among Research Literature 109 11. Data Comparing the Percentage of Injury Types Incurred to Ice Hockey Players Among Research Literature Ill 12. Table Showing Raw Injury Site Data Collected and Percentage of Total Injuries (N = 337) 114 vm Table Page 13. Table Showing the Raw Injury Type Data Collected and Percentage of Total Injuries (N = 312) 116 14. Table Showing the Raw Injury Cause Data Collected and Percentage of Total Injuries (N = 337) 117 15. Table Showing the Raw Injury by Position Data Collected and Percentage of Total Injuries 118 16. Table Showing the Raw Time of Injury Occurrence Data Collected and Percentage of Total Injuries (N = 337) 119 IX List of Figures Figure Page 1. Bar graph representing the injury- rate per 1000 athletic-exposures for MIAA High School, NCAA Division I, and NCAA Division II/III Ice Hockey Goaltenders, Defensive Players, and Forward/Centers 42 2. Bar graph representing the injury rate per 1000 athletic-exposures for MIAA High School, NCAA Division I, and NCAA Division II/III ice hockey athletes. 43 Ice Hockey Injuries 1 Ice Hockey Injuries: A Comparative Study of Incidence and Severity George E. Bullock, Jr., ATC Springfield College Running Head: ICE HOCKEY INJURIES Ice Hockey Injuries 2 Abstract The following study was conducted to compare the frequency, cause, severity, and anatomical location of injuries that occur in NCAA Division I, Division II/III, and Massachusetts Interscholastic Athletic Association (MIAA) Ice Hockey Conferences during the 1994-1995 regular season. Twenty-four Head or Student Athletic Trainers participated in the investigation providing injury information about 332 athletes. Data were analyzed using Pearson's Chi square test that was weighted by the number of injuries per division. All athletes were injured significantly (p < .05) more frequently in games than practice. Division II/III athletes suffered significantly (p < .05) more upper extremity, shoulder, and groin injuries, strains, and injuries caused by the puck and non-contact. High school athletes suffered significantly (p > .05) fewer lower extremity injuries than either Division I or Division II/III athletes. And Division I athletes incurred significantly (p < .05) more back injuries than Division II/III athletes and high school athletes. Severity of injury did not appear to vary across each division and player position did not appear to affect the frequency of injury. Ice Hockey Injuries 3 Ice Hockey Injuries: A Comparative Study of Incidence and Severity Ice hockey is considered to be the fastest and most violent team sport in the world. The popularity of the game of ice hockey has increased enormously in the United States, mostly due to the 1960 Olympic gold medal victory and the nationalistic fervor that accompanied the 1980 repeat of the Olympic ice hockey championship over the Soviet Union (Sim, Simonet, Melton, & Lehn, 1987). Hockey is a fast paced, physically demanding sport that requires the athlete to make quick decisions, even quicker stops and changes of direction, bursts of skating speed, outstanding individual efforts, and precision team plays. Violence is commonplace and injuries are frequent (Brust, Leonard, Pheley, & Roberts, 1992; Finke et al., 1988; Hayes, 1975; McRnight, Ferrera, & Czerwinska, 1992; Pelletier, Montelpare, & Stark, 1993; Rielly, 1982; Sim & Simonet, 1988; Sutherland, 1976). In a discussion of the game, Sim and Simonet (1988), summarized: hockey had been referred to as a game played with clubs (hockey sticks), knives (skates), and bullets (pucks). Because of the increasing popularity of ice hockey in the United States, Ice Hockey Injuries 4 physicians and athletic trainers previously unexposed to the mechanisms and types of injuries are becoming involved in the prevention and treatment of such injuries. (p. 92) Daly, Sim, and Simonet (1990), Downs (1979), and Pashby (1979) noted that especially prevalent in hockey are injuries concentrated about the head, face, and eyes of the participating athlete. Several investigators have suggested that the acceptance of the injuries associated with ice hockey should not be tolerated and certain problem injuries such as those to the head, face, eye, and cervical spine, need to be documented and investigated (Pelletier et al., 1993; Sim & Simonet, 1988; Sim et al., 1987; Tegner & Lorentzon, 1991; Vinger, 1977). The occurrence of potentially devastating injuries such as head, facial, and eye injuries, have prompted many investigations (Pashby, 1979; Vinger, 1977) that have, in turn, influenced the development of and increased the use of ice hockey protective equipment, especially helmet/visors and goaltender face masks. Sim and Simonet (1988) stated that protective equipment is one of the critical Ice Hockey Injuries 5 factors of injury prevention. Promotion of safety through improved equipment had evolved slowly, (however) significant advances have been made in recent years. Improved helmets and face masks have lowered the incidence of facial and eye injuries. (p. 104) Pashby (1979) and Vinger (1977), with their separate efforts to determine specific injury rates and incidence of debilitating eye injuries, including blindness, have influenced the governing bodies of professional and amateur ice hockey in both the United States and Canada. As a result, standardized regulations concerning the use of helmets/visors as a means of player personal protection have been developed.