Bodychecking and concussions in ice hockey: Should our youth pay the price?

Physicians are often called upon to assess youth with hockey-associated traumatic brain injury and to counsel players and their parents about subsequent return to play. Although recommendations about return to play are numerous,17-22 none has been extensively validated.18,23 A considerable number of youth who return to play on the goodwill of these recommendations sustain repeated traumatic brain injuries.18,24-27 None of the recommendations emphasizes the importance of counselling children and their families about the risks of returning to play or the option of not playing in a body-contact league. In our opinion, too much emphasis is placed on when to return to play and not enough on whether to return after an initial traumatic brain injury. To properly counsel players and inform the debate on allowing bodychecking in hockey, physicians must fully appreciate the medical risks associated with bodychecking in hockey. Each season, 10%-12% of minor league hockey players 9-17 years old who are injured report a head injury,45 most commonly a concussion.38,39,52 Concussions are most often caused by body-checking38-40,53 and rarely by being struck with a puck.38 A review of the literature published between 1966 and 1997 revealed that youth aged 5-17 years had about 2.8 concussions per 1000 player-hours of ice hockey; the number per 1000 player-hours was about the same among high school players, as high as 4.2 among university hockey players and 6.6 among elite amateurs.38 Among Canadian amateur hockey players over 18 years old, the rate is 4.6-6.0 concussions per 1000 player-hours.39 When 14 years was the age at which bodychecking was first allowed in British Columbia, 15 years was the average age at which players had their first concussion.39 Undoubtedly, this threshold age will decline as the new rules about bodychecking are implemented across the country. The risks of bodychecking make it clear that checking is not necessary for play at the Canadian minor league hockey level55 - a position supported by the Canadian Academy of Sport Medicine.4 The American Academy of Pediatrics recommends limiting bodychecking among players 15 years of age and less.2 Variations in body size and strength34 occur in all age groups, but they are most pronounced from 13 to 15 years; differences of 53 kg in body mass and 55 cm in height between the smallest and largest players have been reported in this age group.31 Since most physical growth is not complete before a person is 17 o