Optimal relative workload for managing low-injury risk in lower extremities of female field hockey players: A retrospective observational study.

ABSTRACT: Our study aimed to investigate the relative workload that is related to the injury in lower extremities of female field hockey players and to identify the optimal ratio of acute to chronic workloads (ACWR) depending on the playing position to manage low risk of sports-related injuries.Data were collected using a global positioning systems unit on a full-time basis and during competition among 52 players who were enrolled in Korea National Team. The ACWR was calculated by dividing the most recent 1 week workload by the prior 4 weeks workload. Injury risk was calculated for each category from very low to very high based on a z-score.In striker and midfielder, the injury risk was the lowest in the moderate-low category of total distance covered, meters per minute (MpM), repeated high-intensity effort bouts, and acceleration bouts, and the moderate-high category of high-intensity running distance (HID). The injury risk of a defender was the lowest in the moderate-low category of HID and MpM.The ACWR in total distance covered, MpM, repeated high-intensity effort bouts, and acceleration bouts should stay within the moderate-low category in striker and midfielder positions and HID and MpM in defender positions in order to manage low-risk of non-contact and soft tissue injuries in female field hockey players.

The absence of fans removes the home advantage associated with penalties called by National Hockey League referees.

The COVID-19 pandemic has had a major impact on professional sports, notably, forcing the National Hockey League to hold its 2020 playoffs in empty arenas. This provided an unprecedented opportunity to study how crowds may influence penalties awarded by referees in an ecological context. Using data from playoff games played during the COVID-19 pandemic and the previous 5 years (n = 547), we estimate the number of penalties called by referees depending on whether or not spectators were present. The results show an interaction between a team's status (home; away) and the presence or absence of crowds. Post-hoc analyses reveal that referees awarded significantly more penalties to the away team compared to the home team when there is a crowd present. However, when there are no spectators, the number of penalties awarded to the away and home teams are not significantly different. In order to generalize these results, we took advantage of the extension of the pandemic and the unusual game setting it provided to observe the behavior of referees during the 2020-2021 regular season. Again, using data from the National Hockey League (n = 1639), but also expanding our sample to include Canadian Hockey League games (n = 1709), we also find that the advantage given to the home team by referees when in front of a crowd fades in the absence of spectators. These findings provide new evidence suggesting that social pressure does have an impact on referees' decision-making, thus contributing to explain the phenomenon of home advantage in professional ice hockey.

Eliminating buyer's remorse: An examination of the sunk cost fallacy in the National Hockey League draft.

The sunk cost effect describes the tendency to escalate one's commitment toward a certain endeavor, despite diminishing returns, as a consequence of irreversible resource expenditure that has already been made (Organ Behav Hum Decis Process. 1985;35:124). This effect has been observed in a number of professional sports leagues, wherein teams escalate their commitment toward players selected early in the draft, regardless of performance outcomes, due to large financial commitments invested in them (J Sports Econom. 2017;18:282; Adm Sci Q. 1995;40:474). This effect, however, has yet to be explored in the National Hockey League (NHL). The purpose of this study was to test for sunk cost effects in the NHL, by examining the relationship between draft order and playing time, while controlling for a myriad of confounding variables. Findings from our analyses provide support for the existence of this effect in the NHL, as first-round draftees were given significantly more playing time than their peers selected in the second round, regardless of injury, player relocation, penalties, or on-ice performance outcomes. We offer some plausible underlying mechanisms driving this effect. Furthermore, we suggest the observed effects have valuable implications for NHL talent development, given the importance of playing time on various aspects of expertise attainment.

Detailed description of Division I ice hockey concussions: Findings from the NCAA and Department of Defense CARE Consortium.

OBJECTIVE: Since concussion is the most common injury in ice hockey, the objective of the current study was to elucidate risk factors, specific mechanisms, and clinical presentations of concussion in men's and women's ice hockey. METHODS: Ice hockey players from 5 institutions participating in the Concussion Assessment, Research, and Education Consortium were eligible for the current study. Participants who sustained a concussion outside of this sport were excluded. There were 332 (250 males, 82 females) athletes who participated in ice hockey, and 47 (36 males, 11 females) who sustained a concussion. RESULTS: Previous concussion (odds ratio (OR) = 2.00; 95% confidence interval (95% CI): 1.02‒3.91) was associated with increased incident concussion odds, while wearing a mouthguard was protective against incident concussion (OR = 0.43; 95%CI: 0.22‒0.85). Overall, concussion mechanisms did not significantly differ between sexes. There were specific differences in how concussions presented clinically across male and female ice hockey players, however. Females (9.09%) were less likely than males (41.67%) to have a delayed symptom onset (p = 0.045). Additionally, females took significantly longer to reach asymptomatic (p = 0.015) and return-to-play clearance (p = 0.005). Within the first 2 weeks post-concussion, 86.11% of males reached asymptomatic, while only 45.50% of females reached the same phase of recovery. Most males (91.67%) were cleared for return to play within 3 weeks of their concussion, compared to less than half (45.50%) of females. CONCLUSION: The current study proposes possible risk factors, mechanisms, and clinical profiles to be validated in future concussions studies with larger female sample sizes. Understanding specific risk factors, concussion mechanisms, and clinical profiles of concussion in collegiate ice hockey may generate ideas for future concussion prevention or intervention studies.

Team-to-team transmission of COVID-19 in ice hockey games - a case series of players in Finnish ice hockey leagues.

BACKGROUND: The COVID-19 pandemic suspended nearly all team sports globally. The pro series have resumed playing by creating safe bubbles or massive testing protocols. Amateur level sports have also restarted seasons without possibility for such precautions. Our aim was to report the epidemiology of COVID-19 in an amateur ice hockey team and the team-to-team transmission during two games. METHODS: A descriptive brief report based on public statements by the local health authorities and the teams involved. RESULTS: An asymptomatic carrier of COVID-19 in a U-20 ice hockey team infected 22 of 28 team mates. The day before the first players had symptoms, the team had returned from a two games away trip. A few days later COVID-19 was detected in both opposing teams and they were ordered to quarantine. During the two weeks quarantine a total of 24 players from the two opposing teams tested positive. Some of these players were training with senior teams and three additional infected players were detected in two senior teams. In total, 49 infections were detected in five ice hockey teams, and six teams were in quarantine for two weeks. CONCLUSION: An asymptomatic player can potentially endanger the whole season of a team and put opponents in danger as well. We report massive team-to-team transmission of COVID-19 in the U-20 Finnish National Hockey League. In order to prevent spread of COVID-19 in amateur-level team sports, suitable protocols should be established and adopted into daily use.

Epidemiology of injuries in senior men's field hockey: A two-season prospective observational injury surveillance study.

Determining the rate and severity of injuries incurred through sport is accepted as the primary step towards designing, implementing and evaluating injury prevention programmes. The aim of this study was to determine the injury incidence rate and characteristics of male field hockey athletes participating in the Irish Hockey League. Athletes from eight field hockey teams were assigned to an online reporting system, where they logged injuries as they were incurred. Injuries were defined as any physical complaint. Coaches and physiotherapists were contacted weekly to corroborateinjuries. Overall 323 injuries were reported across 34,449 exposure hours, giving rise to an incidence rate of 9.4/1000 h. On average, athletes sustained one injury over the course of two seasons. Muscle strains, pain and contusions were the most common types of injury, while the hamstring, knee and hip/groin were the most frequently reported locations. While 66.9% of injuries occurred through non-contact mechanisms, contact injuries were also common. Injury recurrences accounted for 16.1% of injuries. In conclusion, the incidence of injury in field hockey is high, occurring from a variety of mechanisms. Future injury prevention strategies should prioritise injuries to the hamstring, knee and ankle, and be specific to particular playing positions.

Analysis of doping control test results in individual and team sports from 2003 to 2015.

Background: Determining the prevalence of doping in sport might be useful for anti-doping authorities to gauge the effectiveness of anti-doping policies implemented to prevent positive attitudes toward doping. Using questionnaires and personal interviews, previous investigations have found that the prevalence of doping might be different among different sports disciplines; however, there is no sport-specific information about the proportion of adverse and atypical findings (AAF) in samples used for doping control. The aim of the present investigation was to assess the differences in the frequency of adverse analytical and atypical findings among sports using the data made available by the World Anti-Doping Agency. Methods: The data included in this investigation were gathered from the Testing Figures Reports made available annually from 2003 to 2015 by the World Anti-Doping Agency. These Testing Figures Reports include information about the number of samples analyzed, the number of AAFs reported, and the most commonly found drugs in the urine and blood samples analyzed. A total of 1,347,213 samples were analyzed from the individual sports selected for this investigation, and 698,371 samples were analyzed for disciplines catalogued as team sports. Results: In individual sports, the highest proportions of AAF were 3.3% ± 1.0% in cycling, 3.0% ± 0.6% in weightlifting, and 2.9% ± 0.6% in boxing. In team sports, the highest proportions of AAF were 2.2% ± 0.5% in ice hockey, 2.0% ± 0.5% in rugby, and 2.0% ± 0.5% in basketball. Gymnastics and skating had the lowest proportions at (≤1.0%) for individual sports, and field hockey, volleyball and football had the lowest proportions for team sports (≤1.4%). Conclusion: As suggested by the analysis, the incidence of AAF was not uniform across all sports disciplines, with the different proportions pointing to an uneven use of banned substances depending on the sport. This information might be useful for increasing the strength and efficacy of anti-doping policies in those sports with the highest prevalence in the use of banned substances.

Physical activity and concussion risk in youth ice hockey players: pooled prospective injury surveillance cohorts from Canada.

OBJECTIVE: To examine the association between meeting physical activity (PA) volume recommendations and concussion rates in male ice hockey players aged 11-17 years. DESIGN: Pooled prospective injury surveillance cohort data from the 2011-2012, 2013-2014 and 2014-2015 youth ice hockey seasons. PARTICIPANTS: Male Alberta-based Pee Wee (aged 11-12 years), Bantam (aged 13-14 years) and Midget (aged 15-17 years) ice hockey players participating in any of the three cohorts were eligible (n=1726). A total of 1208 players were included after the exclusion criteria were applied (ie, players with new/unhealed injuries within 6 weeks of study entry, missing 6-week PA history questionnaires, missing game and/or practice participation exposure hours, players who sustained concussions when no participation exposure hours were collected). OUTCOME MEASURES: Dependent variable: medically diagnosed concussion. Independent variable: whether or not players' self-reported history of PA (ie, hours of physical education and extracurricular sport participation) met the Canadian Society of Exercise Physiology and Public Health Agency of Canada recommendation of one hour daily during the 6 weeks prior to study entry (ie, 42 hours or more). RESULTS: The PA volume recommendations were met by 65.05% of players who subsequently sustained concussions, and 75.34% of players who did not sustain concussions. The concussion incidence rate ratios (IRR) reflect higher concussion rates in players who did not meet the PA volume recommendations vs. players who met the PA volume recommendations among Pee Wee players (IRR 2.94 95% CI 1.30 to 6.64), Bantam players (IRR 2.18, 95% CI 1.21 to 3.93) and non-elite players aged 11-14 years (IRR 2.45, 95% CI 1.33 to 4.51). CONCLUSION AND RELEVANCE: The concussion rate of players who did not meet the Canadian PA volume recommendations was more than twice the concussion rate of players who met recommendations among male Pee Wee players, Bantam players and non-elite level players. Further exploration of the impact of public health PA recommendations in a sport injury prevention context is warranted.

Epidemiology of Injuries in Women Playing Competitive Team Bat-or-Stick Sports: A Systematic Review and a Meta-Analysis.

BACKGROUND: Team bat-or-stick sports, including cricket, softball and hockey, are popular among women. However, little is known about the injury profile in this population. OBJECTIVE: The aim was to describe the incidence, nature and anatomical location of injuries in bat-or-stick sports played by women in a competitive league. METHODS: This review was prospectively registered (PROSPERO CRD42015026715). CINAHL, MEDLINE, PsycINFO, PubMed, SPORTDiscus were systematically searched from January 2000 to September 2016, inclusive. Peer-reviewed original research articles reporting the incidence, nature and anatomical location of injuries sustained by women aged 18 + years in competitive bat-or-stick sports were included. Two meta-analyses based on injury incidence proportions (injury IP) and injury rates per 1000 person-days of athletic exposure (AE) were performed. RESULTS: A total of 37 studies satisfied the inclusion criteria, and five had low risk of bias. The weighted injury IP was 0.42 [95% confidence interval (CI) 0.39-0.45]. The weighted injury rate was 6.12 (95% CI 6.05-6.18) overall, and greater in games [15.79 (95% CI 15.65-15.93)] than in practice [3.07 (95% CI 2.99-3.15)]. The ankle was the most commonly injured anatomical location, followed by the hand (including wrist and fingers), knee and head. Soft tissue and ligament injuries were most common types of injuries. CONCLUSION: Injury prevention in women's sports is a novel and emerging field of research interest. This review highlights that injury incidence is high among female bat-or-stick players, but little information is known about direct causal mechanisms. This review clearly establishes the need for enhancements to injury data collection. Without this information, it will not be possible to develop evidence-based injury prevention interventions.

Epidemiology of Hip Flexor and Hip Adductor Strains in National Collegiate Athletic Association Athletes, 2009/2010-2014/2015.

BACKGROUND: Little research has examined the rates and patterns of hip flexor or hip adductor strains in student-athletes in the National Collegiate Athletic Association (NCAA). PURPOSE: To describe the epidemiology of hip flexor and adductor strains in NCAA athletes during the 2009/2010-2014/2015 academic years. STUDY DESIGN: Descriptive epidemiology study. METHODS: Rates and patterns of hip flexor and adductor strains in collegiate sports were examined in a convenience sample of NCAA varsity teams from 25 sports. Rates and distributions of strains by mechanism, recurrence, and participation restriction time were examined. Injury rate ratios (IRRs) and proportion ratios were calculated to compare rates within and between sports by event type, sex, mechanism, recurrence, and participation restriction time. RESULTS: A total of 770 hip flexor and 621 hip adductor strains were reported, resulting in overall injury rates of 1.60 and 1.29 per 10,000 athlete-exposures (AEs), respectively. In men, the rate of hip flexor strains was 1.81 per 10,000 AEs, and that for hip adductor strains was 1.71 per 10,000 AEs. In women, the rate of hip flexor strains was 1.59 per 10,000 AEs, and the rate of hip adductor strains was 1.15 per 10,000 AEs. The highest rates of strains were found in men's soccer and men's ice hockey (range, 2.47-3.77 per 10,000 AEs). Most hip flexor and hip adductor strains occurred in practice, but both had higher rates in competition. In sex-comparable sports, hip flexor strain rates did not differ between the sexes (IRR = 1.14; 95% CI, 0.96-1.36), but the rate of hip adductor strains was higher in men than women (IRR = 1.49; 95% CI, 1.22-1.81). Noncontact was the most common mechanism for both types of strains (hip flexor strains, 59.4%; hip adductor strains, 62.5%); 10.1% of hip flexor strains and 11.1% of hip adductor strains were recurrent. The highest rates of recurrence of both types of strain were found in men's and women's ice hockey (range, 16.0%-30.6%). Most hip flexor and hip adductor strains resulted in <1 week of participation restriction (hip flexor strains, 83.8%; hip adductor strains, 82.9%). CONCLUSION: The NCAA sports with the highest rates of hip flexor and hip adductor strains were men's soccer and men's ice hockey. In sex-comparable sports, men had a higher rate of hip adductor, but not hip flexor, strains. Recurrence rates were remarkably high in ice hockey. Male sports teams, especially soccer and ice hockey, should place an emphasis on prevention programs for hip adductor strains. Secondary prevention programs involving thorough rehabilitation and strict return-to-play criteria should be developed and implemented to curb the high recurrence rate of these injuries, particularly in ice hockey.

Injury Surveillance of Head, Neck, and Facial Injuries in Collegiate Ice Hockey Players, 2009-2010 Through 2013-2014 Academic Years.

CONTEXT: Ice hockey is a high-speed, full-contact sport with a high risk of head/face/neck (HFN) injuries. However, men's and women's ice hockey differ; checking is allowed only among men. OBJECTIVES: To describe the epidemiology of HFN injuries in collegiate men's and women's ice hockey during the 2009-2010 through 2013-2014 academic years. DESIGN: Descriptive epidemiology study. SETTING: Ice hockey data from the National Collegiate Athletic Association (NCAA) Injury Surveillance Program during the 2009-2010 through 2013-2014 academic years. PATIENTS OR OTHER PARTICIPANTS: Fifty-seven men's and 26 women's collegiate ice hockey programs from all NCAA divisions provided 106 and 51 team-seasons of data, respectively. MAIN OUTCOME MEASURE(S): Injury rates per 1000 athlete-exposures and rate ratios with 95% confidence intervals (CIs). RESULTS: The NCAA Injury Surveillance Program reported 496 and 131 HFN injuries in men's and women's ice hockey, respectively. The HFN injury rate was higher in men than in women (1.75 versus 1.16/1000 athlete-exposures; incidence rate ratio = 1.51; 95% CI = 1.25, 1.84). The proportion of HFN injuries from checking was higher in men than in women for competitions (38.5% versus 13.6%; injury proportion ratio = 2.82; 95% CI = 1.64, 4.85) and practices (21.9% versus 2.3%; injury proportion ratio = 9.41; 95% CI = 1.31, 67.69). The most common HFN injury diagnosis was concussion; most concussions occurred in men's competitions from player contact while checking (25.9%). Player contact during general play comprised the largest proportion of concussions in men's practices (25.9%), women's competitions (25.0%), and women's practices (24.0%). While 166 lacerations were reported in men, none were reported in women. In men, most lacerations occurred from player contact during checking in competitions (41.8%) and player contact during general play in practices (15.0%). CONCLUSIONS: A larger proportion of HFN injuries in ice hockey occurred during checking in men versus women. Concussion was the most common HFN injury and was most often due to player contact. Lacerations were reported only among men and were mostly due to checking. Injury-prevention programs should aim to reduce checking-related injuries.

Predicting coin flips: using resampling and hierarchical models to help untangle the NHL's shoot-out.

Roughly 14% of regular season National Hockey League games since the 2005-06 season have been decided by a shoot-out, and the resulting allocation of points has impacted play-off races each season. But despite interest from fans, players and league officials, there is little in the way of published research on team or individual shoot-out performance. This manuscript attempts to fill that void. We present both generalised linear mixed model and Bayesian hierarchical model frameworks to model shoot-out outcomes, with results suggesting that there are (i) small but statistically significant talent gaps between shooters, (ii) marginal differences in performance among netminders and (iii) few, if any, predictors of player success after accounting for individual talent. We also provide a resampling strategy to highlight a selection bias with respect to shooter assignment, in which coaches choose their most skilled offensive players early in shoot-out rounds and are less likely to select players with poor past performances. Finally, given that per-shot data for shoot-outs do not currently exist in a single location for public use, we provide both our data and source code for other researchers interested in studying shoot-out outcomes.

Predictors of Length of Career After Hip Arthroscopy for Femoroacetabular Impingement in Professional Hockey Players.

BACKGROUND: Previous studies have shown that professional hockey players return to sport at a high rate after hip arthroscopy, although it is unknown how long players continue to compete at a professional level after surgery. PURPOSE: To determine the prevalence of athletes who continued playing in the National Hockey League (NHL) for a minimum of 5 years after hip arthroscopy for treatment of symptomatic femoroacetabular impingement (FAI) and to determine predictors associated with length of career. STUDY DESIGN: Case series; Level of evidence, 4. METHODS: A total of 60 professional hockey players (69 hips) underwent hip arthroscopy for FAI by a single surgeon between 2005 and 2010. Data were retrieved from NHL.com and Hockey-reference.com regarding information on each player's professional career. Position played, age, surgical procedure, and intraoperative findings were also used in data analysis. RESULTS: There were 12 centers, 15 defensemen, 16 goalies, and 17 wings studied. Of the 60 athletes, 40 (67%) continued to play professionally a minimum of 5 years after hip arthroscopy. As of the 2015 season, the mean length of a player's NHL career was 13.7 years (range, 2-27 years), with an average of 5.9 years played after hip arthroscopy. There was no difference in length of career or years played when goalies were compared with other positions (P = .760). Length of career and years played after arthroscopy correlated with age at surgery (r = 0.799 and -0.408, respectively). Players who played ≥5 years after arthroscopy were significantly younger than those who did not (25 vs 30 years; P = .001). Athletes who played <5 years after arthroscopy had a longer average duration of symptoms before surgery when compared with those who played ≥5 years (20.2 vs 9.3 months; P = .049). There were no differences in length of career or years played after arthroscopy based on type of labral treatment. CONCLUSION: Professional NHL players who underwent hip arthroscopy for FAI were able to continue playing for an average of 5.9 years after surgery, with 67% playing a minimum of 5 years postoperatively. Younger age and shorter duration of symptoms at time of surgery correlated with greater length of career and years played after hip arthroscopy. Players who did not play a minimum of 5 years postoperatively had significantly longer duration of symptoms before surgery. The study data support early arthroscopic treatment of professional hockey players with symptomatic FAI.

Injury data of major international field hockey tournaments.

BACKGROUND: Detailed injury data are not available for international tournaments in field hockey. We investigated the epidemiology of field hockey injuries during major International Hockey Federation (Fédération Internationale de Hockey, FIH) tournaments in 2013. MATERIALS AND METHODS: FIH injury reports were used for data collection. All major FIH tournaments for women (n=5) and men (n=11) in 2013 were included. The main focus of this study was to assess the pattern, time, site on the pitch, body site and mechanism of each of the injuries. We calculated the average number of injuries per match and the number of injuries per 1000 player match hours. RESULTS: The average number of injuries was 0.7 (95% CI 0.5 to 1.0) per match in women's tournaments and 1.2 (95% CI 0.8 to 1.7) per match in men's tournaments. The number of injuries per 1000 player match hours ranged from 23.4 to 44.2 (average 29.1; 95% CI 18.6 to 39.7) in women and 20.8 to 90.9 (average 48.3; 95% CI 30.9 to 65.8) in men. Most injuries occurred in the circle (n=25, 50%, in women, n=95, 51%, in men). The rate of injuries increased after the first quarter. Injuries to the head and face (n=20, 40%) were most common in women. The head/face (n=51, 27%) and the thigh/knee (n=52, 28%) were equally affected in men. The ball caused the most injuries, followed by the stick, collisions and tripping/falling. There were no deaths or injuries that required hospital treatment in the entire cohort. SUMMARY: Field hockey has a low incidence of acute injuries during competition.

Anterior Cruciate Ligament Injuries in Professional Hockey Players.

BACKGROUND: Performance outcomes and return-to-play data have been reported after anterior cruciate ligament (ACL) injuries in professional football and basketball, but they have rarely been reported in professional hockey. HYPOTHESIS: The hypothesis was that performance after ACL reconstruction would be comparable to prior levels of play in a series of National Hockey League (NHL) players. STUDY DESIGN: Case series; Level of evidence, 4. METHODS: The NHL Injury Surveillance System (ISS) was utilized to identify all players with an ACL injury between 2006 and 2010. Medical staff members for all NHL teams were surveyed regarding these injuries. The medical staff completed a questionnaire for each injury, and statistics were analyzed using multiple analyses of variance to compare outcomes, performance, and the complication rate. A control group was identified and matched based on performance, career length before injury, age, height, and weight. RESULTS: There were 47 players identified by the NHL ISS. There were 3 goalies, 8 defensemen, and 36 wings or centers. The average age of these players was 27.69 years. The average length of time played after the injury was 2.8 years, which was less than that of the control group (4.4 years) (P = .004). The presence of a meniscal injury was associated with a decreased length of career compared with the control group (P = .012) and with patients with an isolated ACL injury (P = .002). For wings and centers, the number of games played decreased from 71.2 to 58.2 in the first full season after the injury (P = .05) and to 59.29 in the second season (P = .03). In the first season after the injury, for forwards and wings, assists and total points decreased from 20.3 and 35.2 to 13.8 (P = .005) and 25.9 (P = .018), respectively. In the second season after the injury, assists and goals decreased to 10.0 (P = .002) and 10.0 (P = .013), respectively. Compared with controls, the per-season averages of goals (P = .001), assists (P = .010), and total points (P = .004) decreased. Four players (8.5%) had subsequent failure of reconstruction, and there was a total reoperation rate of 20%. Five players (10.6%) did not return to play, and 4 (8.5%) were unable to return to play for a full season. CONCLUSION: Most players are able to return to play in the NHL after an ACL injury. However, career length and performance may be significantly decreased compared with controls. This may represent a more severe initial injury, and more focused return-to-play pathways may identify barriers to return to play.

When Is It Too Early for Single Sport Specialization?

Over the past 15 years, there has been an increase in youth sports participation with a concomitant increase in early year-round training in a single sport. Many factors contribute to the desire of parents and coaches to encourage early single sport specialization, including the desire to give the young athlete an edge in competition, pursuit of scholarships, and potential professional status, and the ability to label a young athlete as elite at an early age. Despite these perceived advantages, some data suggest that early sport specialization does not lead to a competitive advantage over athletes who participate in multiple sports. Although the data are limited, there is some evidence that early sport specialization may put the young athlete at risk for overuse injuries. The focus of this review is to highlight the evidence regarding early sport specialization and risk for injury; discuss the risk factors for overuse injury in high-risk sports including ice hockey, swimming, gymnastics, and baseball; and discuss future potential research that would help define the risk of injury for young athletes who participate in early sport specialization.

Early death in active professional athletes: Trends and causes.

The objective of the study was to examine mortality trends and causes of death among professional athletes from the four major sports in North America who died during their playing careers. 205 deceased athletes who were registered as active when they died from the National Basketball Association (NBA), National Football League (NFL), National Hockey League (NHL), and Major League Baseball (MLB) were examined. Results were compared with the Canadian and U.S. general population. The leading causes of death in players reflected the leading causes of death in the Canadian and U.S. general population (i.e., car accidents). Descriptively, NFL and NBA players had a higher likelihood of dying in a car accident (OR 1.75, 95% CI: 0.91-3.36) compared with NHL and MLB players. In addition, NFL and NBA players had a significantly higher likelihood of dying from a cardiac-related illness (OR 4.44, 95% CI: 1.59-12.43). Mortality trends were disproportionate to team size. Overall, death in active athletes is low. Out of 53 400 athletes who have historically played in the four leagues, only 205 died while active (0.38%). Future examinations into the trends and causes of mortality in elite athlete populations will create a better understanding of health-related risks in elite sport.

Ice hockey injuries among United States high school athletes from 2008/2009-2012/2013.

BACKGROUND: The popularity of ice hockey has grown in recent years and injuries are a concern given the physical nature of the sport. We sought to report the rates, mechanisms, and severity of boys' US high school ice hockey injuries. We hypothesized that body checking would be a major source of injury and that concussions would be common. We also expected to find that competition would have a higher rate of injury than practice. DESIGN: Descriptive epidemiology study. METHODS: Boys' US high school ice hockey injury data from 2008/2009 through 2012/2013 academic years were obtained from the National High School Sports-Related Injury Surveillance System, High School Reporting Information Online database. The primary outcome was rate of injury per 10,000 athlete exposures (AEs). RESULTS: Overall, 724 boys ice hockey injuries occurred during 311,817 AEs for an injury rate of 23.2 per 10,000 AEs. Injury rates were significantly higher during competition compared to practice (rate ratio = 7.8, 95% confidence interval: 6.5-9.4). Concussion was the most frequent injury reported at a rate of 6.4 per 10,000 AEs. Body checking was the mechanism of injury in over 46% of injuries. The head/face/neck region (33.8%) and upper arm/shoulder region (20.6%) were the most commonly injured body sites. Just over 6% of injuries resulted in surgical intervention. CONCLUSION: Injuries among high school ice hockey athletes are common. Increases in the number of high school ice hockey injuries will likely parallel the increase in high school ice hockey participation in the United States.

A systematic video analysis of National Hockey League (NHL) concussions, part I: who, when, where and what?

BACKGROUND: Although there is a growing understanding of the consequences of concussions in hockey, very little is known about the precipitating factors associated with this type of injury. AIM: To describe player characteristics and situational factors associated with concussions in the National Hockey League (NHL). METHODS: Case series of medically diagnosed concussions for regular season games over a 3.5-year period during the 2006-2010 seasons using an inclusive cohort of professional hockey players. Digital video records were coded and analysed using the Heads Up Checklist. RESULTS: Of 197 medically diagnosed concussions, 88% involved contact with an opponent. Forwards accounted for more concussions than expected compared with on-ice proportional representation (95% CI 60 to 73; p=0.04). Significantly more concussions occurred in the first period (47%) compared with the second and third periods (p=0.047), with the majority of concussions occurring in the defensive zone (45%). Approximately 47% of the concussions occurred in open ice, 53% occurred in the perimeter. Finally, 37% of the concussions involved injured players' heads contacting the boards or glass. CONCLUSIONS: This study describes several specific factors associated with concussions in the NHL, including period of the game, player position, body size, and specific locations on the ice and particular situations based on a player's position.

Etiologic factors of ice hockey injuries in Korean high school players.

BACKGROUND: Ice hockey is a competitive sport and ice hockey injuries can be influenced by many physical and psychological factors. Young ice hockey players are especially vulnerable to injury due to their relative lack of experience and rapid physical growth during their juvenile years. Up to now there has been no survey of the physical, psychological, and environmental etiological factors based on the Korean high school ice hockey players population. PURPOSE: The purpose of our study was to evaluate, through a comprehensive survey, the incidence of ice hockey injuries according to age and the relationship between etiological factors and injuries in high school students. STUDY DESIGN: A cross-sectional study. METHODS: One hundred nineteen ice hockey players in Korean high schools were recruited for this study. The study was conducted by a self-administered questionnaire survey. The researcher explained the purpose of the survey and how to fill it out. Individual questionnaires were distributed to participants. Chi-squared tests were used to evaluate the relationship between the independent and dependent values. There was a significant difference between a player's age and injury incidence (P = .018). The injury level of each position showed a significant tendency (P = .055). Age was highly correlated with the number of total injuries (P = .019). RESULTS: The average demographic characteristics of those surveyed were age (16.7 years), play line (2.2), height (174.8 cm), weight (69.6 kg), and body mass index (23.4). The shoulder was the most frequent injury area and the knee was the most common cause of hospital visits. There was a higher injury incidence in older groups; however, there was no correlation with body mass index, position, and play line. The causative factors were divided into physical factors, psychological factors, and environmental factors. Generally, 3 factors were not closely regarded as etiologic factors of ice hockey injury. However, deficiency of fitness in the physical factor, aggressiveness in the psychological factor, and injury by other players in the environmental factor showed a high etiological correlation for ice hockey injury. CONCLUSION: The multiple aspects of this etiological factor analysis showed modest results. However, based on our results, in order to reduce the long-term implications of youth ice hockey injuries and associated public health costs, comprehensive efforts, including psychological and environmental factor modification, should be put in place.