University of Calgary PRISM: University of Calgary's Digital Repository Graduate Studies The Vault: Electronic Theses and Dissertations 2021-04-30 Youth Ice Hockey Related Injury and Concussion: Informing Prevention Through Modifiable Risk Factors Eliason, Paul Hamilton Eliason, P. H. (2021). Youth Ice Hockey Related Injury and Concussion: Informing Prevention Through Modifiable Risk Factors (Unpublished doctoral thesis). University of Calgary, Calgary, AB. http://hdl.handle.net/1880/113348 doctoral thesis University of Calgary graduate students retain copyright ownership and moral rights for their thesis. You may use this material in any way that is permitted by the Copyright Act or through licensing that has been assigned to the document. For uses that are not allowable under copyright legislation or licensing, you are required to seek permission. Downloaded from PRISM: https://prism.ucalgary.ca UNIVERSITY OF CALGARY Youth Ice Hockey Related Injury and Concussion: Informing Prevention Through Modifiable Risk Factors by Paul Hamilton Eliason A THESIS SUBMITTED TO THE FACULTY OF GRADUATE STUDIES IN PARTIAL FULFILMENT OF THE REQUIREMENTS FOR THE DEGREE OF DOCTOR OF PHILOSOPHY GRADUATE PROGRAM IN KINESIOLOGY CALGARY, ALBERTA APRIL, 2021 © Paul Hamilton Eliason 2021 Abstract Ice hockey is a popular sport in Canada, yet is considered a high-risk sport for injury. To prevent these injuries, potential risk factors must be identified to inform injury prevention strategies. Further, injury prevention strategies that have been implemented should be evaluated to ensure no unintended injury consequences have occurred. In this dissertation, the potential risk factors for injury and prevention strategies in youth ice hockey are reviewed and limitations of the literature are discussed to help inform the next steps for injury prevention. The association between on-ice skill performance and injury is also examined. This will help provide a better understanding of the potentially modifiable risk factors for injury in youth ice hockey and will further aid in the development of targeted interventions. Additionally, the rates of injury and concussion among under-15 (ages 13-14) ice hockey players playing in leagues allowing body checking, but who have varying years of body checking experience is explored. Finally, the association of body checking experience and rates of injury and concussion in under-18 players (ages 15-17) are assessed. These evaluations will provide important evidence for recent and potentially future body checking policy changes in youth ice hockey. Policy permitting body checking continues to be the most relevant modifiable risk factor in youth ice hockey. A faster time on the transition agility (suggesting higher skill) was associated with a higher rate of injury among 11-17-year-olds. Among 13-14-year-olds participating in a body checking league, there were no significant differences in the rates of injury or concussion among players that had no body checking experience and those that had either 1 year or 2+ years of experience. Among 15-17-year-olds, the adjusted rates of injury and concussion were higher among those with more body checking experience (≥3 years) than those ii with less experience (≤2 years). These studies provide further evidence in support of disallowing body checking in younger age groups in youth ice hockey to reduce injury and concussion rates, with no adverse consequences related to less body checking experience when engaged in leagues allowing body checking in older age groups (ages 13-17). iii Acknowledgements This dissertation is the result of the many people who have been a part of this chapter in my life. First and foremost, I would like to acknowledge my mentor and supervisor, Dr. Carolyn Emery. I cannot thank her enough for her tremendous guidance, encouragement, and for the support she has provided both professionally and personally. This was especially true during challenging times. I am forever indebted to her for the opportunities she has provided me. To my committee members, Dr. Luz Palacios-Derflingher and Dr. Brent Hagel, thank you for your continued direction on these projects. Your time, knowledge, and ongoing support have been instrumental in getting me to this point. A special thank you to Dr. Willem Meeuwisse for encouraging me to further my education and for his mentorship. I would also like to thank Dr. Kati Pasanen who kindly agreed to supervise me while Dr. Emery was on sabbatical. As I reflect on my graduate experience, I find myself extremely fortunate to have had such amazing peer-mentorship. These friends and colleagues, listed in no particular order, include Dr. Amanda Black, Dr. Sarah Kenny, Dr. Kerry MacDonald, Dr. Tracy Blake, Dr. Carly McKay, and Dr. Jackie Whittaker. I will always smile when I think about our times at SIPRC together and look forward to whenever our paths cross. I met some incredible friends along this journey. These people know who they are, and I thank them all for the memories we have shared. I eagerly await to see where the next pages take us. Lastly, to my family, who keep my heart full of love. This is as much yours as it is mine. iv Dedication This dissertation is dedicated to the man I aspire to be, my dad. v Table of Contents Abstract ............................................................................................................................... ii Acknowledgements ............................................................................................................ iv Dedication ............................................................................................................................v Table of Contents ............................................................................................................... vi List of Tables .......................................................................................................................x List of Figures and Illustrations ......................................................................................... xi List of Symbols, Abbreviations and Nomenclature .......................................................... xii CHAPTER ONE: INTRODUCTION ..................................................................................1 1.1 Background ................................................................................................................1 1.1.1 Sport Injury Prevention .....................................................................................2 1.1.2 Sequence of Sport Injury Prevention .................................................................2 1.1.3 Sport Injury Prevention Strategies and Unintended Consequences ..................2 1.2 Research Rationale ....................................................................................................3 1.3 Purpose .......................................................................................................................4 1.4 Summary of Format ...................................................................................................4 CHAPTER TWO: INJURIES IN YOUTH ICE HOCKEY: INFORMING THE NEXT STEPS FOR INJURY PREVENTION .......................................................................6 2.1 Participation and Injury Burden .................................................................................6 2.2 Sequence of Sport Injury Prevention .........................................................................7 2.3 Dynamic, Recursive Model of Etiology for Sport Injury ..........................................8 2.4 Injury Rates ................................................................................................................9 2.5 Potential Risk Factors for Injury in Youth Ice Hockey ...........................................10 2.5.1 Extrinsic, Non-modifiable Risk Factors ..........................................................11 2.5.1.1 Age Group and Relative Age .................................................................11 2.5.1.2 Session Type ..........................................................................................12 2.5.1.3 Level of Play ..........................................................................................12 2.5.1.4 Player Position .......................................................................................13 2.5.1.5 Team Performance .................................................................................13 2.5.2 Intrinsic, Non-modifiable Risk Factors ...........................................................13 2.5.2.1 Sex and Gender ......................................................................................13 2.5.2.2 Previous Injury/Concussion History ......................................................14 2.5.2.3 Player Size .............................................................................................14 2.5.3 Intrinsic, Potentially Modifiable Risk Factors .................................................15 2.5.3.1 Preseason Reporting of Neck Pain, Headaches, and/or Dizziness ........15 2.5.3.2 Strength Measures ..................................................................................15 2.5.3.3 Psychosocial Factors ..............................................................................15 2.5.3.4 Physical Activity Levels ........................................................................16 2.5.4 Extrinsic, Potentially Modifiable Risk Factors ...............................................16