While there is inherent risk for concussion in any sport, hockey is widely recognized as one with a higher incidence rate.
Why? Well, it’s simple.
The game is played on a sheet of ice. A sheet of ice that is surrounded by boards and glass. Players travel on steel blades at blurring speeds – up to 30 km per hour. It’s fast. There’s body contact – which is often encouraged at some levels. It’s aggressive. Players are armed with composite hockey sticks and believe they are fully protected by their equipment. They rapidly hop over the boards to join the play, and relentlessly compete for possession of a hard rubber disk.
Concussions do happen in hockey…
Hockey has all the elements of an extremely exciting and entertaining sport. And yes, we are a little biased because it’s our national sport in Canada. And yes, most hockey parents and players are aware that concussions can happen. They are very difficult to fully prevent given the situation explained above.
In fact, concussions have been proven to occur at all skill and age levels, and sources show that they account for up to 14% of all hockey injuries, and up to 30% of all hockey head injuries.
We are advocates of sport, and the benefits they can offer to children, youth and even adults. We stress the importance of concussion recognition and proper post-injury management. Concussion is a treatable injury.
We also support the use of preseason multimodal baseline testing, which can be a valuable tool for high-risk athletes, and provide important information to help inform return to play decisions. It’s another hurdle a player must jump in order to return to play safely. Sure, a baseline test may ultimately delay a players’ return to ice, but importantly, it is one of the better ways to reduce the risk for further injury and long-term complications due to concussion.
So, how do concussions happen in hockey?
Given what we know about concussion injuries, and the fact that it is an acceleration or deceleration injury, there are a number of ways a concussion could happen on the ice. Hockey Canada explains the cause of concussion on their website.
Importantly, there are a number of risks factors, including age, height, weight, gender, level of play, position, programs in place, and more that could have an impact on the prevalence of these injuries.
How do concussions happen in hockey?
- Intentional hits to the head: It may seem obvious, but hits to the head cause more concussions than hits to the body. Avoid contact to the head whenever you can. Keep your shoulders, elbows, arms and fists down. There are accidents and incidental contact, but if we’re all more aware on the ice, we can reduce the risk.
- Checking from behind: Do not do this! A player facing the boards is in a very vulnerable position. An impact from behind makes them susceptible to injury. They are not prepared for an impact, and a hit from behind will likely cause the head to whip back and forth, or send them crashing into the boards. This is a dangerous play.
- Body checking: This has been removed from the game at some minor hockey levels, which is a good thing. We’re not going to get into the debate here, but it’s clear that any contact sport has inherent risk for head injuries. Players unprepared for an impact such as those looking the wrong way or watching a pass with their head down are often at higher risk.
- Colliding with teammates or opposing players: This is a very common way that concussions occur. Neither player is expecting an impact, which puts them at significant risk. Keep your head up, and work on awareness on the ice.
- Puck or stick to the head or face: This is less likely than the scenarios above, but it can happen.
- Fighting: Fighting in hockey is less common at the minor and youth levels, but definitely something that’s hotly debated at the professional level. Any time punches are thrown, there is a risk for concussion. Interestingly, a 2016 documentary titled Ice Guardians suggested that less 5% of concussions in NHL hockey was due to fighting. Another great debate for another day.
Are concussions in hockey preventable?
Given the nature of the game, in our opinion, the only way to fully prevent a concussion would be to stop playing altogether. That doesn’t sound like a reasonable option, in our opinion.
That said, there are some things your league could do to help reduce the risk:
- Education, awareness and protocols: Education and awareness is often the first step towards proper injury management. Research shows that most concussed patients can make a full recovery; however, receiving a second concussion prior to full recovery of the first could lead to long-term complications. Having concussion protocols in place can encourage proper recognition, management and recovery.
- Annual comprehensive, multimodal baseline testing (for some levels and age groups): At the time of this blog post, baseline testing is one the best ways to reduce the risk for further injury and long-term complications. How? By knowing what an athlete is capable of in a healthy state, it allows healthcare practitioners to make better decisions regarding recovery and when it is safe for the athlete to return to their sport after a concussion.
- Consider your position: If you’re more prone to injury or had previous concussions, you may want to consider a different position. An NHL study showed that forwards are more susceptible to concussions because there are more of them on the ice, and they often move at a higher speed. They also have the puck more often. 
- Always use caution, particularly early on in a game: Research shows that in game awareness is one of the ways to reduce concussion risk. If a player knows they are going to be hit, they can brace for the impact. An NHL study showed that more concussions occur in the first period, when teams try to “set the tone” early. Be ready as soon as the puck drops.
- Enforce the rules: Oftentimes, plays that cause a concussion aren’t recognized as a penalty. Referees and coaches have an obligation to enforce the rules and call penalties. These repercussions for on-ice actions could reduce inappropriate behaviour. Eliminating checks to the head, hits from behind or other dangerous plays can also help. Some leagues should consider limiting intentional contact in younger age groups.
- Practice make progress: Ensure that concussion awareness measures and prevention techniques are used in practice. The more players become accustomed to this style of play in practice, the more likely they will use it in games. Further, strong skill development and in-game awareness (or “Hockey IQ” – think of the Great One, Wayne Gretzky) may help players anticipate and avoid high risk plays.
- Make sure equipment fits: Wear equipment that fits properly and is Hockey Canada, USA Hockey and/or CSA approved. All hockey equipment including helmets, mouth guards and neck guards should be worn consistently and correctly, and be in good shape.
- RESPECT: Having respect for opposing players as well as the coaches and referees can help to keep everyone safe.
Have anything else to add? Leave a comment.
Click here for more information about our concussion programs and policies for amateur and professional sports organizations, or click here for information about how to get your team baseline testing.
 Facts and Prevention. Hockey Canada. Available at: www.hockeycanada.ca/en-ca/hockey-programs/safety/concussions/facts-and-prevention
 Concussions – and how to prevent them – top of mind as NHL training camps begin. NHL. Available at: www.nhl.com/news/concussions-and-how-to-prevent-them-top-of-mind-as-nhl-training-camps-begin/c-588737