Incidence of Head Contacts, Penalties, and Player Contact Behaviors in Youth Ice Hockey: Evaluating the “Zero Tolerance for Head Contact” Policy Change

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Objective:Ringette and female ice hockey are high participation sports in Canada. Despite policies disallowing body checking, both sports have high injury and concussion rates. This study aimed to compare physical contact (PC), head contact (HC), and suspected injury and concussion incidence rates (IRs) in female varsity ringette and ice hockey.Design:Cross-sectional.Setting:Canadian ice arenas.Participants:Eighteen Canadian female university ringette and ice hockey tournament/playoff games in the 2018-2019/2019-2020 seasons.Assessment of Risk Factors:Game video-recordings were analyzed using Dartfish video-analysis software to compare both sports.Main Outcome Measures:Univariate Poisson regression analyses (adjusted for cluster by team, offset by game-minutes) were used to estimate PC, HC, and suspected injury IRs and incidence rate ratios (IRRs) to compare rates across sports. Proportions of body checks (level 4-5 trunk PC) and direct HC (HC1) penalized were reported.Results:Analyses of 36 team-games (n = 18 ringette, n = 18 hockey) revealed a 19% lower rate of PCs in ringette than ice hockey {IRR = 0.81 [95% confidence interval (CI), 0.73-0.90]}, but a 98% higher rate of body checking [IRR = 1.98 (95% CI, 1.27-3.09)] compared to ice hockey. Ringette had a 40% higher rate of all HC1s [IRR = 1.40 (95% CI, 1.00-1.96)] and a 3-fold higher rate of suspected injury [IRR = 3.11 (95% CI, 1.13-8.60)] than ice hockey. The proportion of penalized body checks and HC1s were low across sports.Conclusions:Body checking and HC1 rates were significantly higher in ringette compared to ice hockey, despite rules disallowing both, and very few were penalized. These findings will inform future injury prevention research in ringette and female ice hockey.

Section: Discussionsupporting

confidence: 56%

“…This aligns with the literature that suggests many contacts in ringette and male ice hockey are deliberate in nature. 4,21 Given that many contacts are deliberate, this finding suggests that perhaps prevention strategies targeting better enforcement of rules are necessary in both ringette and female ice hockey.…”

Section: Discussionmentioning

confidence: 99%

Higher Rates of Head Contacts, Body Checking, and Suspected Injuries in Ringette Than Female Ice Hockey: Time to Ring in Opportunities for Prevention

Heming

Sobry

Cairo

et al. 2022

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“…Building on previous research by Krolikowski et al 19 and Williamson et al, 15 this study aimed to investigate additional rule modifications regarding the national "zero tolerance for HC" policy in U15 Canadian youth ice hockey. Previously with the implementation of the HC policy, increased rates of concussion (presumably because of increased concussion awareness and reporting over the study period) were found.…”

Section: Discussionmentioning

confidence: 99%

“…15 In both cohorts, less than 14% of direct player-inflicted HC (HC1s) were penalized during play. 15 Potentially stricter enforcement or rule modifications were needed to increase player safety. Hockey Canada's 2018 to 2020 rule amendments have not been previously evaluated in youth ice hockey.…”

Section: Introductionmentioning

confidence: 99%

“…14,21 No statistical difference in HC incidence rates (both direct and indirect HC) or the proportion of HCs penalized pre-HC-policy and post-HCpolicy change emerged. 15 In both cohorts, less than 14% of direct player-inflicted HC (HC1s) were penalized during play. 15 Potentially stricter enforcement or rule modifications were needed to increase player safety.…”

Section: Introductionmentioning

confidence: 99%

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Does Increasing the Severity of Penalties Assessed in Association With the “Zero Tolerance for Head Contact” Policy Translate to a Reduction in Head Impact Rates in Youth Ice Hockey?

Williamson

Kolstad

Nadeau

et al. 2022

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Objective:The risk of concussion is high in Canadian youth ice hockey. Aiming to reduce this burden, in 2011, Hockey Canada implemented a national “zero tolerance for head contact (HC)” policy mandating the penalization of any player HC. In 2018 to 2020, Hockey Canada further amended this HC policy including stricter enforcement of severe HCs. This study aimed to compare HC rates, head impact location, and HC enforcement prepolicy, postpolicy, and after policy amendments in elite U15 Canadian youth ice hockey.Design:This is a prospective cohort study.Setting:A collection of events with the video camera located at the highest point near center ice in public ice hockey arenas in Calgary, Alberta.Participants:A convenience sample of 10 AA U15 games prepolicy (2008-2009), 8 games postpolicy (2013-2014), and 10 games after policy amendments (2020-2021).Independent Variables:An analysis of 3 cohort years regarding the HC-policy implementation and amendments.Main Outcome Measures:Using Dartfish video-analysis software, all player contacts and HCs [direct (HC1), indirect (eg, boards, ice) (HC2)] were tagged using validated criteria. Univariate Poisson regression clustering by team-game offset by game length (minutes) was used to estimate incidence rates (IR) and incidence rate ratios (IRR) between cohorts.Results:With additional rule modifications, a 30% reduction in HC1s emerged (IRR2013-2020 = 0.70, 95% CI, 0.51-0.95). Since the HC-policy implementation, HC1s decreased by 24% (IRR2008-2020 = 0.76, 95% CI, 0.58-0.99). The proportion of HC1s penalized was similar across cohorts (P2008-2009 = 14.4%; P2013-2014 = 15.5%; P2020-2021 = 16.2%).Conclusions:The HC-policy amendments have led to decreased HC1 rates. However, referee enforcement can further boost the HC-policy effectiveness. These findings can help future referee training and potential rule modifications to increase player safety nationally.

Can Referees Assess Head Contact Penalties Correctly in Canadian Youth Ice Hockey? A Video Analysis Study

Williamson¹,

Kolstad

Eliason³

et al. 2023

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Objective: To help address the high concussion burden in Canadian youth ice hockey, our primary objective was to examine the concurrent validity of youth ice hockey referees' ability to assess head contacts (HCs) and associated penalties using video analysis methods after implementation of the "zero tolerance for HC" policy by Hockey Canada. Study Design: Cross-sectional study. Participants: Certified Level II-III referees in Alberta, Canada. Intervention: A secured online survey with 60 videos (10 to 15 seconds) containing a player-to-player physical contact with or without a HC from elite U15 (ages 13 to 14) youth ice hockey games. Outcome Measures: Survey questions were completed by all referees for each video, including (1). 'Did you see a player-toplayer contact?', (2). 'Should a penalty be assessed?', and if yes, (3). 'Which player, penalty type, and penalty intensity?' Referee assessments were compared with a consensus agreement from 2 national and member (top level) gold standard referees for concurrent validity through percent agreement and sensitivity/specificity measures. Results: Complete-case analysis of 100 referees (131 recruited) showed an overall median agreement of 83.5% (sensitivity 5 0.74; specificity 5 0.69) with the gold standard. Agreement with the gold standard was highest for HC infractions [85.1% (sensitivity 5 0.80; specificity 5 0.69)], followed by HC penalty type (81.5%) and penalty intensity (53.7%). Conclusions: Concurrent validity through percent agreement was high (.80%) compared with the gold standard for identifying both HC and other infractions; however, it was moderate for penalty intensity. Although knowledge of identifying HCs and penalties in this survey was acceptable, this study suggests in-game factors (eg, game management and positioning) may be a primary limitation for HC enforcement.