Head and neck ice hockey injuries in children: an analysis of the NEISS database.

OBJECTIVE: Our objective was to describe non-concussion head and neck ice hockey injuries in children in the US. METHODS: This is a retrospective cohort study using data from the NEISS database. The NEISS database was reviewed from 2010 to 2021 for injuries in the head, neck, mouth, eye, and ear related to ice hockey in children 1-18 years old. Records where the only injury was a concussion or internal head injury were removed. Frequencies were calculated and chi-squared tests were performed. RESULTS: 475 children were included, with mean age of 13.1 years old (95 % CI 12.7-13.4), and 426 (89.7 %) were male. Females were significantly younger with mean age 11.8 years versus 13.2 years for males (t = -2.4, df = 473, p = .018). 110 (23.2 %) injuries were related to hockey sticks, 92 (19.4 %) involved a fall, and 32 (6.7 %) were subsequent to body checking. 301 of the injuries (63.4 %) were lacerations, 71 (14.9 %) contusions or abrasions, and 26 (5.5 %) strains and sprains. The type of injury varied according to head and neck region (p < .001). 231 (82.8 %) of facial injuries, 16 (76.2 %) of ear injuries, and 33 (62.3 %) of oral injuries were lacerations. Eight (1.7 %) patients were admitted or observed overnight, while the rest were discharged home. CONCLUSION: Female ice hockey players sustain injuries at younger ages than males, which may reflect the loss of older girls from the sport. In older boys, injury rates may reflect the loss of mandated full face protective shields.

The relationship between off-ice testing and on-ice performance in male youth Ice hockey players.

Introduction: Ice hockey demands a unique blend of physical fitness and skill, necessitating a comprehensive understanding of the factors influencing on-ice performance. The present study was designed to examine the relationship between off-ice and on-ice performance measures in male, youth, ice hockey players. Methods: Eleven minor hockey players (Age = 9.8 ± 1.1 years) participated in two testing days: (1) off-ice and (2) on-ice assessments. Off-ice assessments included maximal aerobic power, anaerobic fitness, muscular strength (handgrip and single leg squat), muscular endurance (curl-ups and push-ups), muscular power (standing long jump and vertical jump), and 30 m sprinting speed and acceleration. On-ice testing included a 15.2 m maximum speed test, a 6.1 m acceleration test with a continuation into a 47.9 m top speed test, an agility cornering S turn test, and a shot velocity test. Results: Twenty-four out of 33 off-ice variables were significantly correlated with at least one of the 11 on-ice performance variables. From those 24, 10 were included as predictors for at least one of the on-ice performance variables. Each model was composed of either one or two predictors, where the most common predictors were 30 m Run - Split (6.1 m) Sprint time and 30 m Run - Total (30 m) Sprint Max speed (included in four out of 11 models each). The prediction formulas R2 and coefficient of variation ranged from 0.63% to 0.96% and 1.2% to 15.3%, respectively. Discussion: Diverse off-ice measures of aerobic fitness, anaerobic power, muscular strength, power, and endurance, and sprinting speed, acceleration, and agility are predictive of on-ice performance. The insights gained from this study contribute to the refinement of assessment protocols, fostering a comprehensive approach to optimizing player performance and potential. Understanding the connection between objective off-ice testing and on-ice performance can support tailored training programs and player development in male youth ice hockey.

Transcranial Direct-Current Stimulation Over the Primary Motor Cortex and Cerebellum Improves Balance and Shooting Accuracy in Elite Ice Hockey Players.

PURPOSE: To investigate the effects of transcranial direct-current stimulation (tDCS) applied over the primary motor cortex (M1) and cerebellum on balance control and shooting accuracy in elite ice hockey players. METHODS: Twenty-one elite ice hockey players underwent anodal tDCS over the M1 (a-tDCSM1), anodal tDCS over the cerebellum (a-tDCSCB), concurrent dual-site anodal tDCS over the M1 and the cerebellum (a-tDCSM1+CB), and sham stimulation (tDCSSHAM). Before and after receiving tDCS (2 mA for 15 min), participants completed an ice hockey shooting-accuracy test, Pro-Kin balance test (includes stance test and proprioceptive assessment), and Y-balance test in randomized order. RESULTS: For static balance performance, the ellipse area in the 2-legged stance with eyes open and the 1-legged stance with the dominant leg significantly improved following a-tDCSM1, a-tDCSCB, and concurrent dual-site a-tDCSM1+CB, compared with tDCSSHAM (all P < .05, Cohen d = 0.64-1.06). In dynamic balance performance, the average trace error of the proprioceptive assessment and the composite score of the Y-balance test with the dominant leg significantly improved following a-tDCSM1 and concurrent dual-site a-tDCSM1+CB (all P < .05, Cohen d = 0.77-1.00). For the ice hockey shooting-accuracy test, shooting-accuracy while standing on the unstable platform significantly increased following a-tDCSM1 (P = .010, Cohen d = 0.81) and a-tDCSCB (P = .010, Cohen d = 0.92) compared with tDCSSHAM. CONCLUSION: tDCS could potentially be a valuable tool in enhancing static and dynamic balance and shooting accuracy on unstable platforms in elite ice hockey players.

Safe2Play in youth ice hockey: injury profile and risk factors in a 5-year Canadian longitudinal cohort study.

INTRODUCTION: Ice hockey is a popular global sport with growing participation for boys and girls yet remains a high-risk sport for injury. While the evidence for some risk factors, such as bodychecking policy is well established, other risk factors such as player sex have been understudied. The objectives of this study were to examine factors associated with rates of game-related injury, game-related injury resulting in >7 days of time-loss, and practice-related injury in youth ice hockey. MATERIALS AND METHODS: Safe2Play was a five-year prospective cohort study (2013-2018). All injuries were identified using validated injury surveillance methodology. Multilevel Poisson regression (adjusting for cluster by team and including multiple imputation of missing covariates) was used to estimate incidence rate ratios (IRRs) for player sex, age group, bodychecking policy, year of play, level of play, weight, previous injury within last 12 months, previous lifetime concussion history, and position. RESULTS: A total of 4418 male and female ice hockey players (representing 6584 player-seasons) participating in under-13 (ages 11-12), under-15 (ages 13-14) and under-18 (ages 15-17) age groups were recruited. There were 1184 game-related and 182 practice-related injuries. Factors associated with game-related injury included female sex (IRR = 1.57; 95% CI: 1.18-2.08), previous injury (IRR = 1.46; 95% CI: 1.26-1.70) and lifetime concussion history (IRR = 1.41; 95% CI: 1.23-1.62). Goaltenders had a lower rate of injury (IRR = 0.54; 95% CI: 0.40-0.72) relative to forwards, as did players exposed to policy disallowing bodychecking in games (IRR = 0.44; 95% CI: 0.35-0.55). Female sex (IRR = 1.90; 95% CI: 1.10-3.28) and lifetime concussion history were also significantly associated with practice-related injury (IRR = 1.53; 95% CI: 1.08-2.18). CONCLUSIONS: Based on data from a large 5-year Canadian youth ice hockey longitudinal cohort, several factors associated with injury were identified. Future injury prevention strategies should consider age, sex, previous concussion and injury history, and body checking leagues. Future research in female youth ice hockey including female-only leagues should be a priority to inform prevention strategies in this understudied population.

Relationships between sprint skating performance and insole plantar forces in national-level hockey athletes.

BACKGROUND: Sprint skating is essential for competitive success in hockey. Previous studies have highlighted various measures of lower-body strength and power as key factors influencing sprint performance. However, while these studies have indicated a significant association between the ability to exert greater force and impulse into the ice surface, and the capacity to achieve faster sprint skating speeds, the direct relationship between these factors remains largely inferred. RESEARCH QUESTION: What are the relationships between insole plantar force variables, sprint skating performance, and their association with physical capacity measures, in national-level male hockey athletes? METHODS: Athletes (n=13) performed 25 m sprint skating trials with insole force sensors and completed: ankle dorsiflexion and hip abduction range-of-motion (ROM), countermovement jump (CMJ), seated single-leg jump, and 10-5 repeated-hop test (RHT) assessments. RESULTS: Relationships were assessed using Kendall's Tau rank correlations (τ), with significant relationships identified between mean relative weight acceptance impulse [WAI] and 0-5 m (τ=0.47) and total distance (τ=0.46) times. Additionally, significant associations were observed between mean relative WAI and: CMJ relative eccentric deceleration impulse (τ=0.44), CMJ eccentric peak velocity (τ=-0.46) and RHT concentric impulse (τ=-0.56). Finally, significant relationships were identified between mean relative PI for all strides and the 10-20 m split, with peak velocity (PV) (τ=-0.58 to -0.73); and between ankle dorsiflexion ROM and PV (τ=-0.57). SIGNIFICANCE: Athletes with faster initial acceleration and overall sprint performance times demonstrated lower relative WAI during their strides and employed a jump strategy that optimized concentric impulse with a rapid eccentric phase. To attain a high PV the athletes appeared to require a stride that maximized glide and minimized vertical force, with greater ankle dorsiflexion ROM potentially facilitating this.

Motivations for Using Dietary Supplements in Elite Ice Hockey-Controlling Weight and Enhancing Performance.

Background: Excessive or improper use of dietary supplements (DSs) by athletes may cause adverse effects, such as impaired performance or failing a doping test, making it important for athletes to mitigate risk and make well-informed choices when using supplements. Methods: This study used focus group interviews to examine the attitudes, motivations, and practices related to DSs among male elite ice hockey players. Results: The players used a wide range of products, ranging from vitamins to multi-ingredient pre-workout supplements. Consuming DSs was considered as a practical and convenient way to ingest sufficient calories to gain or maintain the body weight and muscle mass needed to meet the physical requirements of the sport. The athletes demonstrated a lenient and ignorant attitude when acquiring and using supplements, with a non-critical trust in the guidance provided to them by the coach or physician. Having completed basic anti-doping education in the form of an e-learning program did not appear to result in taking a more careful approach to using DSs. Conclusions: Through their DS practices, elite ice hockey players may put themselves at risk for anti-doping rule violations. A comprehensive approach is needed when aiming to prevent unintentional doping in this athlete cohort.

Dual career in sport and non-sport work: Exploring experiences of North American professional female ice hockey players.

Grounded in role strain theory, this study explored the dual career experiences of North American female ice hockey players who were also involved in full-time non-sporting work, focusing on factors that produced and reduced their role strain. We interviewed ten professional ice hockey players who held full-time non-sport jobs at the time of their interview. Our reflexive thematic analysis revealed that the multitude of factors leading to role strain among professional female working-athletes were notably significant, spanning societal expectations and environmental complexities. The imposition of the superwoman persona, demanding excellence in both hockey and work roles, combined with inconsistent expectations from professional and athletic supervisors intensified stress and undermined well-being. The study's findings emphasize the need for robust support systems and adaptive strategies, such as effective communication, careful planning, and proactive self-care, which can mitigate these pressures. Furthermore, the athletes' narratives revealed a pressing call for empathy and flexibility from coaches, employers, and the broader sports community, suggesting that improvements in these areas could enhance the professional and personal experiences of these working-athletes. The findings provide valuable insights into the challenges faced by dual career female athletes, as well as current strategies aimed at supporting and enhancing their experiences. Furthermore, these results deepen our understanding of how professional female athletes in North America can achieve greater well-being by addressing the factors that produce and reduce role strain factors.

Inter-Segment Coordination of Male and Female Collegiate Ice Hockey Players During Forward Skating Starts.

Purpose: Coordination in ice hockey skating has been minimally investigated, particularly in females. The objective was to compare lower-extremity inter-segment coordination of collegiate male and female ice hockey players during forward skating starts. Methods: 3D kinematic data were collected on collegiate male (n = 9) and female (n = 10) participants during accelerative steps. Continuous relative phase (CRP) was calculated for shank-sagittal/thigh-sagittal, shank-sagittal/thigh-frontal, and foot-sagittal/shank-sagittal segment pairs across 2.5 strides on each side. Principal component analysis (PCA) extracted features of greatest variability of the CRP and relationships between principal components and sex were investigated using hierarchical linear model. Results: Males demonstrated more out-of-phase coordination (higher CRP) for side one (p = .01) and side two (p < .01) shank-sagittal/thigh-sagittal as well as side one shank-sagittal/thigh-frontal (p < .01) segment pairs throughout each step. Females demonstrated a greater change in CRP from late stance/early swing to late swing/early stance on side two for shank-sagittal/thigh-frontal segments (p < .01). For side two shank-sagittal/thigh-frontal segments, faster males utilized more out-of-phase coordination throughout each step whereas faster females utilized more in-phase coordination (p < .01). Conclusion: Males and females may employ different coordinative strategies to achieve faster skating speeds. Males tend to utilize more out-of-phase coordination of the shank and thigh throughout strides, although coordinative differences of the shank and foot were not found between sexes. Further investigation is needed to examine the relationship between lower limb strength and coordination as well as the effect of targeted training protocols on lower extremity coordinative patterns.

Development and experiences of an internet-based acceptance and commitment training (I-ACT) intervention in ice hockey players: a qualitative feasibility study.

Internet-based psychological interventions have increased the accessibility of evidence-based treatments in clinical psychology but are still an unexplored delivery format in sport psychology research. This study describes the development and evaluates the experiences of an internet-based acceptance and commitment therapy/training (I-ACT) intervention in ice hockey players focusing on performance enhancement and a sustainable sport participation. I-ACT consisted of seven weekly modules and the feasibility of the intervention was investigated using a qualitative research design. Four national level ice hockey players took part of I-ACT and were interviewed about their experiences using a semi-structured protocol. Interview transcripts were analyzed using qualitative content analysis. Findings suggest that the content of I-ACT was comprehensible, relevant, and that it was possible to put the psychological skills into practice. I-ACT was described as helpful to the ice hockey players either in their sport performance or in their life outside of sport. The internet-format was generally perceived as positive, flexible, and a feasible option for delivering psychological interventions in an elite sport context. Some concerns were raised regarding the timing of the intervention at the end of the season, and some players also wished for more time to complete I-ACT. It was also expressed that some of the exercises could have been better adapted for goaltenders. Further trials are needed to evaluate the effects of I-ACT on performance and mental health outcomes in various sport populations using robust quantitative research methodology. Internet-based psychological interventions are a potential future opportunity to make evidence-based practices more accessible for athletes.

Analysis of Injuries in the Swiss U20 Elite Ice Hockey Season 2019/2020-A Retrospective Survey.

(1) Background: In Switzerland, there is little data on injury characteristics in elite ice hockey players aged under 20 years (U20 Elite juniors). This study aimed to determine the injury rate and type of injury in Swiss U20 ice hockey players. (2) Methods: The present study was carried out in a retrospective, non-experimental design using an online questionnaire provided to the 314 elite players of the 12 Swiss U20 Elite ice hockey teams. The injury rate, rate ratios, injury location, type and severity of injury, and injury mechanism were reported. (3) Results: Seventy-three athletes from 11 teams volunteered (response rate = 24%). A total of 30 out of 45 recorded injuries led to time loss in practice and competition. Injury occurred once or twice during the 2019/2020 season. For each player, the injury rate was 0.66 per 1000 practice hours and 2.98 per 1000 competition hours (injury rate ratio = 4.5). The head/neck region was the most common injury location (45.5%). (4) Conclusions: Knowledge of injury characteristics in ice hockey is necessary for meaningful injury management and injury prevention. The results of the present study provide information on the injury rate, location, types, severity, and mechanism in elite Swiss U20 ice hockey players. Most injuries result from contact with another player. More strict sanctioning for irregular behavior and fair play can serve as preventive measures. Further studies should examine different preventive measures such as wearing full-face coverage.

An in-depth analysis of wound incidence and injury status among professional athletes: A comprehensive review.

This review aims to synthesize current knowledge on the incidence, characteristics and management of wounds and injuries among professional ice hockey athletes, with the specific focus on the emerging population of Chinese female players. An extensive literature search was conducted across several databases to gather data on injury patterns and wounds, causes, severity and prevention strategies in ice hockey. Special attention was given to studies involving female athletes and unique challenges faced by players in developing regions like China. The review also examined the impact of training modalities, protective equipment and medical interventions on injury rates. The findings reveal a significant seasonal fluctuation in wound incidence, with marked reduction following the preseason period. This trend underscores the effectiveness of adjusted training programmes and essential role of medical teams in injury prevention and rehabilitation. Analysis did not show significant difference in wound rates between technical and physical training sessions, suggesting that injuries are pervasive risk across all training activities. Skating, collisions and inadequate warm-ups were identified as the leading causes of wounds, highlighting areas for targeted preventive measures. The distribution of wounds across various body regions pointed to knee, lower back and wrist as the most vulnerable sites, necessitating focused protection and training adjustments. Ice hockey, particularly among female athletes in China, presents complex injury landscape characterized by the wide range of wounds. The study emphasizes the necessity of comprehensive, multidisciplinary approach to injury prevention that includes training modifications, enhanced protective gear and strategic medical oversight. By addressing the specific causes and patterns of injuries identified, stakeholders can better protect athletes from the inherent risks of the sport, promote safer play and extend career longevity.

Investigating the Relevance of Maximal Speed and Acceleration in Varsity-Level Female Ice Hockey Players.

PURPOSE: To characterize and compare female ice hockey players' peak skating speed and acceleration ability during linear sprints and gameplay. We also sought to quantify the time spent at various speeds and the frequency of accelerations at different thresholds during games. METHODS: Seventeen varsity-level female ice hockey players (20 [1.4] y, 68.9 [4.9] kg, 167.6 [4.7] cm) participated in an on-ice practice session (performing 3 × 40-m linear sprints) and 4 regular-season games while being monitored using a local positioning system. Speed and acceleration were recorded from the sprint and within-game monitoring. Time on ice spent in relative skating speed zones and the frequency of accelerations at different intensities were recorded. RESULTS: Players' greatest peak speeds (29.5 [1.3] vs 28.3 [1.1] km/h) and accelerations (4.39 [0.48] vs 3.34 [0.36] m/s2) reached during gameplay were higher than those reached in linear sprinting (both P < .01). Peak in-game values were moderately predicted by linear sprint values for speed (r = .69, P < .01) but not for acceleration (r < .01, P = .95). Players spent little time at near-peak linear sprint speeds (≥80% [22.7 km/h], ∼3% time on ice; ≥90% [25.5 km/h], <1% of time on ice) during gameplay. However, 26% to 35% of accelerations recorded during the 4 games were ≥90% of linear sprint acceleration. CONCLUSIONS: Although skating speed may be advantageous in specific game situations, our results suggest that players spend little time at near-maximal speeds while accelerating frequently during games. This warrants further investigation of direction changes, skating transitions, repeated sprints, and other determinant variables potentially related to on-ice success and the implementation of training strategies to improve repeated acceleration or qualities beyond maximal skating speed.

Injury rate and characteristics in Japanese male professional ice hockey players: prospective study of 60 players over 10 seasons.

Objectives: We aimed to assess the injury rate and characteristics in Japanese male professional ice hockey players. Methods: This study involved an inclusive cohort of male ice hockey players from a Japanese professional team competing in the 2010-2011 through the 2019-2020 seasons. An injury was defined as the 'time-loss and medical attention' definition of the International Ice Hockey Federation. All injuries that occurred during games and practice sessions were recorded daily on injury charts by the team athletic trainers and/or physician. Game-related injury rates were analysed using both the athlete-at-risk (AAR) and time on ice (TOI) methods. Results: Sixty players were included in the study. A total of 479 injuries were recorded, with 307 (64%) occurring during 451 games and 172 (36%) occurring during the practice sessions. The game-related injury rates obtained using the AAR and TOI methods were not statistically different (p>0.05): 115.3 (95% CI 107.1 to 123.1) and 116.8 (95% CI 109.9 to 124.7) per 1000 player-game hours, respectively. Most injuries involved the upper extremities (39.9% game-related, 32.6% practice-related), followed by the lower extremities (23.5% game-related, 32.5% practice-related). The most frequent mechanism of game-related injury was body checking (45.4%). Conclusion: We observed a higher injury rate in a Japanese male professional team compared with rates reported in other leagues. The reported injury characteristics should help to improve injury prevention strategies that should target shoulder dislocations caused by body checking, and finger or wrist fractures resulting from contact with a hockey stick or puck impact.

In search for climate neutrality in ice hockey: A case of carbon footprint reduction in a Finnish professional team.

Mitigation actions in all sectors of society, including sports, to limit global warming have become an increasingly hot topic in public discussions and sports management. However, so far, there has been a lack of understanding and practical examples of how these organizations, especially in team sports, can holistically assess and reduce their climate impacts to achieve carbon neutrality. This paper presents a carbon footprint assessment, implemented actions for GHG emission reduction, and offers the example of a professional Finnish ice hockey team that achieved carbon neutrality. The study is based on a life cycle assessment method. The Results show that the team's carbon footprint was reduced from 350 tCO2eq by more than 50% between seasons 2018-2019 and 2021-2022 in the assessed categories. The most GHG emission reductions were achieved in the team's and spectators' mobility and ice hall energy consumption. Furthermore, the team compensated for their remaining emissions to achieve carbon neutrality. Multiple possibilities for further GHG emission reductions were recognized. The majority of the GHG emissions were linked to the Scope 3 category, indicating that co-operation with partners and stakeholders was a key to success in attaining carbon neutrality. This paper also discusses the possible limitations and challenges that sport organizations face in assessing climate impacts and reducing GHG emissions, as well as the prospects of overcoming them. Since there are many opportunities for sports to contribute to climate change mitigation, relevant targets and actions to reduce GHG emissions should be integrated into all sport organizations' management.

The Coronal Alignment of Lower Limbs in the Adolescent Football and Ice Hockey Players.

Background: To investigate the influence of sport-specific activities on coronal axial alignment of the lower limbs in adolescent football and ice hockey players. Methods: This cross-sectional study targeted healthy adolescent male football and ice hockey players with at least 3 years of sports participation. 90 football and 38 ice hockey players aged 12-16 years were divided into five age-matched subgroups. Coronal alignment of the lower limbs was determined by measuring the players' intercondylar or intermalleolar (ICD-IMD) distance with a custom-made calliper. In addition, their sports history was recorded. An age-matched comparison between the two sports groups was performed using the two-way model ANOVA and a multiple regression model for ICD-IMD was constructed. Results were additionally compared with age-matched data from the general population published in recent literature. Results: A statistically significant increase in ICD-IMD values (p < 0.05) was found between 12 (football 0 mm; ice hockey - 64 mm) and 16 years (football 340 mm; ice hockey 310 mm) in both sports groups. Results of regression analysis of pooled group data showed that ICD-IMD has low positive correlation (r = 0.407; r2 = 0.168; p < 0.05) with time of participation in sport, but no association with age of athletes at the start of their sport participation (r = - 0.018; r2 = 0.000; p > 0.05). There were no statistically significant differences between the two groups at any time point. Both sports groups showed a significant increase in ICD-IMD values (mean 198 mm) after the age of 14 compared to the general population. Conclusions: Participation in football and ice hockey is associated with a similar increase in ICD-IMD in the adolescent years in male athletes. The observed increase was higher in both groups of athletes than in their peers who do not regularly participate in sports. Level of Evidence: Level 4 (case series).

Cross-Sectional Study of the Anthropometric Profile and Nutrient Status of Elite Female Ice Hockey Players: Differences by Play Position.

Both the characteristics of ice hockey and the environmental conditions in which it is played affect the maintenance of the player's nutritional status and, therefore, their state of health and performance. The primary aim of this work was to examine the anthropometric profile, estimated energy expenditure, and macronutrient and micronutrient dietary intake of elite female ice hockey players by play position. As a secondary aim, their dietary intakes were compared with the recommendations. Hypotheses suggest variations in body composition based on ice hockey players' positions, with the expectation that these athletes may not align with energy and nutrient recommendations. Fifteen elite female ice hockey players were anthropometrically measured, basal metabolic rate and total energy expenditure were estimated, a 3-day, 24 h recall questionnaire was registered, and the results were compared with the recommended dietary intake for the Spanish population. Each player's position on the field requires an individualized physical and nutritional approach. There are no significant imbalances (p > 0.05) between energy and nutrient intake in relation to the Recommended Daily Intake (RDI); however, increasing the consumption of vegetables and seafood while reducing meat and fat intake would assist these athletes in maintaining a healthier energy balance, optimizing body composition, and aligning with nutritional parameters that are better suited to enhance physical performance.

Initial versus Subsequent Injury and Illness and Temporal Trends Among Professional Hockey Players.

Background: Research is limited investigating injuries/illness incidence among National Hockey League (NHL) players. This study sought to establish injury/illness incidence, initial versus subsequent injury risk among NHL players, and determine temporal trends of injury and illness incidence. Hypothesis: Variations in injury incidence by body region, and initial versus subsequent injury would be observed among positions. Study Design: Retrospective cohort study. Methods: Publicly available data were utilized. NHL players 18 years or older between 2007-2008 to 2018-2019 were included. Injury and illness was stratified by position and body segment. Incidence rate (IR), and initial versus subsequent injury and illness risk ratios were calculated. Temporal trends were reported. Results: Nine thousand, seven-hundred and thirty four injuries and illnesses were recorded. Centers had the highest overall IR at 15.14 per 1000 athlete game exposures (AGEs) (95%CI:15.12-15.15) and were 1.4 times more likely to sustain a subsequent injury compared to other positions. The groin/hip/thigh was the most commonly injured body region with an IR of 1.14 per 1000 AGEs (95%CI:1.06-1.21), followed by the head/neck (0.72 per 1000 AGEs, 95%CI:0.66-0.78). Combined injury and illness IR peaked in 2009-2010 season at 12.01 (95%CI: 11.22-12.79). The groin/hip/thigh demonstrated peak incidence during the 2007-2008 season (2.53, 95%CI:2.17-2.90); head/neck demonstrated a peak incidence in 2010-2011 season (Overall: 1.03, 95%CI:0.81-1.26). Injuries reported as 'lower body' increased over time. Conclusions: Positional differences were observed; centers demonstrated the highest overall IR, and subsequent injury risk. Injury by body region was similar to previous literature. Head/neck and concussion decreased over time supporting rule changes in body checking and visor wear. Clinicians should be aware that 'lower body' injuries increased over time; therefore, injuries to the groin/hip/thigh or knee are likely underreported. Level of Evidence: Level 3.

Medicalization of Sport? A Mixed-Method Study on the Use of Medications in Elite Ice Hockey.

Ice hockey is a high-risk sport known for its dominant macho culture. The purpose of this study was to examine experiences surrounding medication use among male, elite ice hockey players in Norway. A mixed-method design was employed, which first examined medications registered on doping control forms (DCFs) (n = 177) and then involved semi-structured focus group interviews (n = 5) with elite athletes (n = 25). Overall, 68% of the DCFs contained information about ≥1 medication. Among the most registered medications were NSAIDs and hypnotics (20% and 19% of all DCFs, respectively). During the interviews, numerous athletes reported using analgesics to manage injuries and pain caused by the sport, often being motivated by sacrificing themselves for the team during important matches and playoffs. Hypnotics were used due to high cumulative stress due to heavy training and competition load, late-night matches, and playing in a semi-professional league. Athlete support personnel (ASP), including physicians and trainers, were the athletes' main sources of information. The athletes often displayed a profound and non-critical trust in the advice and products provided to them by their team physician. The findings indicate that male, elite ice hockey players, through their excessive and somewhat ignorant use of medications, expose themselves to health risks and inadvertent doping.