Cervical Spine Injuries in the Ice Hockey Player: Current Concepts in Epidemiology, Management and Prevention

Abstract

Study Design: This review article examines the biomechanics that underly hockey-related cervical spine injuries, the preventative measures to curtail them, optimal management strategies for the injured player and return to play criteria. Objective: Hockey is a sport with one of the highest rates of cervical spine injury, but by understanding the underlying pathophysiology and context in which these injuries can occur, it is possible to reduce their incidence and successfully manage the injured player. Methods: Multiple online databases including PubMed, Google Scholar, Columbia Libraries Catalog, Cochrane Library and Ovid MEDLINE were queried for original articles concerning spinal injuries in ice hockey. All relevant papers were screened and subsequently organized for discussion in our subtopics. Results: Cervical fractures in ice hockey most often occur due to an increased axial load, with a check from behind the most common precipitating event. Conclusions: Despite the recognized risk for cervical spine trauma in ice hockey, further research is still needed to optimize protocols for both mitigating injury risk and managing injured players.

Chasing the Cup: A Comprehensive Review of Spinal Cord Injuries in Hockey

“…The risk of a catastrophic spinal injury after returning to ice hockey needs to be addressed thoroughly on a case-by-case basis and prior guidelines have been developed to stratify patients into categories of risk based on their clinical presentation [51][52]. Despite agreement on fundamental criteria such as complete pain freedom, full cervical range of motion, full strength, and no residual neurologic deficits, there is still no consensus on the optimal management of cervical spine injuries in most sports, let alone ice hockey specifically [53]. Future research should be directed at improved injury recognition technologies as well as the development of more cohesive and standardized return-to-play guidelines.…”

Sports-Related Cervical Spine Injuries – Background, Triage, and Prevention

“…In fact, there is some data to suggest that the incidence of spinal cord injury in ice hockey is 3 times as high as in football. 14,15 Additionally, there is literature to suggest that there are 15 incidences of catastrophic spinal injury in Canada in the United States annually, 16,17 and that 1/ 3 of patients who sustained spinal cord injuries playing hockey would be wheelchair-bound for life. 18 Interestingly, in 1 study which examined the incidence of spinal cord injury secondary to hockey in Canada, there was a notable increase in injuries between the 1980s and 1990s.…”

“…15 As is the case with all sport-related cervical spine injuries, the primary goal of initial fieldside treatment (after securing ABCs), is cervical spine stabilization. 15,20 This controversy is based on conflicting literature -some of which focuses upon the risk, and additional angular displacement associated with helmet removal, whereas other literature is more concerned with the often loose fit of hockey helmets which can lead to additional injury and improper stabilization in transport. 15,20,21 At the core of this debate is which strategy will lead to less head movement, and therefore, decreased risk of further cervical injury.…”

“…Much like football, hockey is a high-contact sport, and has, therefore, also been associated with spinal cord injury. In fact, there is some data to suggest that the incidence of spinal cord injury in ice hockey is 3 times as high as in football 14,15 . Additionally, there is literature to suggest that there are 15 incidences of catastrophic spinal injury in Canada in the United States annually, 16,17 and that 1/3 of patients who sustained spinal cord injuries playing hockey would be wheelchair-bound for life 18 .…”

“…Additionally, although axial load is thought to be the primary force-vector leading to cervical injury in both hockey players and football players, the mechanism of injury is slightly different in hockey 18 . Specifically, 1 large study found that collision of the helmeted head with the boards (causing a downward axial force in a semi-flexed neck) after being checked from behind was the most common cause of spinal cord injury in Canadian hockey players 15,18 . It has also been hypothesized that much as in football, the use of advanced protective equipment has actually been harmful rather than helpful, as it has given players a false sense of security and therefore increased aggressiveness and decreased caution 18 …”