Concussions in the National Hockey League: Analysis of Incidence, Return to Play, and Performance

Abstract

Background: Concussion injuries are common in professional hockey; however, their effect on player performance remains unclear. Purpose: To quantify the effect of concussions on the performance of position players in the National Hockey League (NHL). Study Design: Cohort study; Level of evidence, 3. Methods: Concussion data from the NHL were collected using publicly available databases for the seasons between 2009-2010 and 2015-2016, coinciding with new NHL concussion rules. Age, body mass index, position, number of concussions during a player’s NHL career, games played, and time on ice were recorded. Basic and advanced performance metrics were collected for 1 season pre- and postconcussion (short-term period) and 3 seasons before and after concussion (long-term period) to assess short- and long-term changes in performance. A control group of players without an identified concussion who competed during the study period was assembled for comparison. Wilcoxon signed rank tests were used to evaluate pre- to postconcussion data in the short- and long-term settings as well as to compare the cohorts at each time point. Results: Overall, 48 players were identified as having a concussion during the study period. Players missed 17.2 ± 15.1 days (mean ± standard deviation) and 7.5 ± 6.9 games postconcussion. There were no significant differences in any metric when pre- and postconcussion intraseason performance was assessed. Athletes who were concussed demonstrated significantly deceased performance metrics (assists per 60 minutes, points per 60 minutes, Corsi percentage, and Fenwick percentage) in the 3 years after the concussion as compared with the year before injury ( P < .05). However, no difference was found between the concussed group and matched control group in the short- or long-term period. Players with concussion played fewer career games (856.4 ± 287.4 vs 725.7 ± 215.0; P < .05) than did controls. Conclusion: A high rate of NHL players were able to return to play after a concussion injury. Players with concussion did not experience a reduction in performance metrics in the short- or long-term setting when compared with matched controls. The concussed cohort maintained a similar workload up to 3 seasons postconcussion but played in fewer career games when compared with matched controls.

Two Minutes for Roughing: A National Analysis of Ice Hockey Injuries from American Trauma Centers

“…One patient died in hospital (<1%) after severe TBI (Table 4). Median hospital LOS was 2 [1][2][3] days and median ICU LOS was 2 [1-2] days.…”

“…1 Despite this enthusiasm and relatively robust literature on the sport in many ways, national-level analyses of patient demographics, clinical characteristics, and injury data are lacking. In hockey and other contact sports, attention has recently been given to injury prevention, especially in terms of head, 2,3 face, 4-7 and mouth 8-10 injuries. Helmets, visors, and mouthguards are frequently required to play hockey, as injuries can be sustained via a number of different mechanisms including falling on the ice or into the boards, puck strike, or contact with another player.…”

Subconcussion, Concussion, and Cognitive Decline: The Impact of Sports Related Collisions

“…As for professional sports, A 2018 study on concussion numbers in National Football League (NFL) reported an average greater than one concussion for every two games [ 36 ]. While a 2022 study reported concussion prevalence in the National Hockey League (NHL) to be one concussion for every 17 games [ 37 ].…”

Analysis of Player Performance and Financial Costs Associated With Implementation of an Updated National Hockey League Concussion Protocol: A Retrospective Comparative Study

“…Because of the intense physical nature of hockey, many players will experience some injury during their career, many of which will be significant enough to cause missed game time. 2 Of these injuries, concussions are prevalent, with an incidence of up to 5.8 to 6.1 per 100 games. 2 , 3 Concussions are considered a form of mild traumatic brain injury, and the pathogenic mechanism involves diffuse axonal injury due to the shearing of axons in the brain.…”

“… 2 Of these injuries, concussions are prevalent, with an incidence of up to 5.8 to 6.1 per 100 games. 2 , 3 Concussions are considered a form of mild traumatic brain injury, and the pathogenic mechanism involves diffuse axonal injury due to the shearing of axons in the brain. 29 Overall, concussions have short-term, severe effects on performance 18 , 24 and cause long-lasting changes in both cerebrovascular and cognitive function.…”