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Epidemiology-Ice Hockey

Ice hockey continues to be increasingly popular throughout the United States and Canada. In contrast to American football, hockey experienced a marked increase in the occurrence of cervical spine injuries since 1980. The Canadian surveys performed by Tator et al.

From 1966 to 1993 reported a total of 241 spinal fracture and dislocations related to hockey. Almost 90% of these injuries were neck related and occurred between C1 and the cervicothoracic junction. An alarmingly increased rate had been documented from 1982 to 1993, with an average of 16.8 fractures/dislocations per year.

Of the 207 athletes in the Canadian registry with adequate documentation of neurological status, 108 (52.2%) sustained a permanent spinal cord injury, and in 52 (25.1%), the cord lesion was complete. Eight players died as a result of complications of their spinal cord injury.

The annual incidence of spinal cord damage with paralysis is at least threefold greater in Canadian hockey than in American football. We have noted before that overall total catastrophic neck injuries are reportedly higher in football, but this is attributed to increased participation. Hockey seems to pose a much higher rate and total number of permanent paralysis and death because of spinal injury.

Checking an opponent from behind (“boarding”) has been identified as an important causative factor of cervical spine trauma in hockey. This playing tactic typically produces a head-first collision of the checked player with the boards. In an effort to prevent these injuries, rule changes have been adopted that prohibit both checking from behind and checking of an opponent no longer controlling the puck.

Data from the Canadian registry suggest that fewer cases of major spinal column trauma and complete quadriplegia have been caused by illegal playing techniques since the institution of these rule changes. Furthermore, educational programs, such as the Safety Toward Other Players (STOP) program, have helped to decrease injury by providing a visual reminder (in the shape of a Stop sign) on the back of players’ jerseys to prevent checking from behind

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