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Acu e inju ies in male eli e ice hockey playe s : A p ospec i e coho s udy
© 2024 The Au ho s. Published by Else ie L d on behal o Spo s Medicine Aus alia.
Published e sion
Hi elä, Jussi; Tuominen, Ma kku; Ai aksinen, Ola i; Hänninen, Timo; Lindblad,
Niklas; Ryhänen, Hilkka; Tikan o, Jukka; Pa kka i, Ja i
Hi elä, J., Tuominen, M., Ai aksinen, O., Hänninen, T., Lindblad, N., Ryhänen, H., Tikan o, J., &
Pa kka i, J. (2024). Acu e inju ies in male eli e ice hockey playe s : A p ospec i e coho s udy.
JSAMS Plus, 4, A icle 100068. h ps://doi.o g/10.1016/j.jsampl.2024.100068
2024
Acu e inju ies in male eli e ice hockey playe s. A p ospec i e coho s udy
Jussi Hi el€
a
a
,
*
, Ma kku Tuominen
b
, Ola i Ai aksinen
c
, Timo H€
anninen
d
, Niklas Lindblad
e
,
Hilkka Ryh€
anen
,
i
, Jukka Tikan o
g
, Ja i Pa kka i
h
,
d
a
Tampe e Uni e si y, The Facul y o Medicine and Heal h Technology, Tampe e, Finland
b
Medispo L d, Tampe e, Finland
c
Uni e si y o Eas e n Finland, Kuopio, Finland
d
Tampe e Resea ch Cen e o Spo s Medicine, UKK Ins i u e, Tampe e, Finland
e
Te eys alo Tu ku Spo Clinic, Tu ku, Finland
Sa asai aala, Po i, Finland
g
Depa men o O o hinola yngology, Oulu Uni e si y Hospi al, Oulu, Finland
h
Facul y o Spo and Heal h Sciences, Uni e si y o Jy €
askyl€
a, Jy €
askyl€
a, Finland
i
Uni e si y o Helsinki, Finland
ARTICLE INFO
Keywo ds:
Ice hockey
Inju y
Epidemiology
Concussion
ABSTRACT
Backg ound: In Finland, eli e le el ice hockey inju y s udies ha e no been conduc ed since 1990s. Epidemiological
da a is needed o de eloping inju y p e en ion. The aim o his s udy was o calcula e he inju y incidences and
o desc ibe de ails o he inju ies in he men's eli e-le el ice hockey league in Finland (Liiga).
Me hods: Du ing he h ee seasons o 2017–2020, inju ies om eigh Liiga eams we e documen ed by eam
physicians o a digi alized inju y- epo ing sys em. All acu e inju ies equi ing medical a en ion o causing a
playe 's ime loss we e epo ed. Inju y incidences we e calcula ed, and inju y de ails we e desc ibed.
Resul s: O e all, 326 inju ies occu ed in 1147 ma ches, comp ising an inju y a e (IR) o 12.9 pe 1000 playe -
games. The head, including ace, was he mos commonly inju ed body pa (IR 4.7 pe 1000 playe -games; 36.2%
o he inju ies), ollowed by he uppe ex emi y (IR 3.5; 27.3%) and lowe ex emi y (IR 3.3; 25.8%). Concussions
we e mo e equen (IR 1.9) han knee (IR 1.6) o shoulde (IR 1.2) inju ies. Body checking (31.5%) was he mos
common mechanism o inju y, and con usion (29.3%) was he mos ypical diagnosis. The playe 's ime loss was
o e h ee weeks in 17.7% o all inju ies, o which mos ly we e knee (23.1%), hand (21.2%) and shoulde
(13.5%) inju ies.
Conclusions: The inju y a e was sligh ly lowe han in o he eli e-le el ice hockey s udies and 28.2% lowe han in
p e ious s udies conduc ed in Finland in he 1990s. Head inju ies we e he mos common. Concussions pe sis ed
as equen inju ies in eli e ice hockey.
1. In oduc ion
Ice hockey is a high-speed con ac spo played especially in Eu ope
and No h Ame ica. Compa ed o o he win e spo s, ice hockey has an
a e age isk o inju y [1–3]. Al hough playe s wea a comp ehensi e
amoun o p o ec i e equipmen , inju ies occu du ing he in ensi e 60
min game. Fo example, when colliding a a as pace wi h he o he
playe s, he puck, o he boa ds o he ice hockey ink, he playe s' issues
a e p one o acu e and epe i i e ans e s o kine ic ene gy, which may
lead o inju ies [4]. In men's ice hockey, he body check ( o obs uc
ano he playe by ackling him a he o so) is allowed, he eby leading o
epe i i e collisions be ween a hle es. Rule in ingemen s, such as
checking o he head, checking om behind, and high-s icking, also occu
and can p esen inju y isks o he playe s [5]. A consensus s a emen
issued by he In e na ional Olympic Commi ee (IOC) defined an inju y
as an e en ei he equi ing medical a en ion o causing a playe 's ime
loss om he spo [4]. Howe e , an inju y can also be defined as any
complain ha nega i ely a ec s a playe 's pe o mance.
* Co esponding au ho . Tampe e Uni e si y, The Facul y o Medicine and Heal h Technology, Kauppi campus, A o building, A o Ylp€
on ka u 34, 33520, Tampe e,
Finland.
E-mail add esses: [email p o ec ed] (J. Hi el€
a), ma kku. uominen@medispo .fi(M. Tuominen), ola i.ai aksinen@pshy in oin ialue.fi(O. Ai aksinen),
imo.hanninen@fimne .fi(T. H€
anninen), [email p o ec ed] (N. Lindblad), hilkka. yhanen@sa a.fi(H. Ryh€
anen), jukka. ikan o@oulunka pa .fi
(J. Tikan o), ja i.p.pa kka i@jyu.fi(J. Pa kka i).
Con en s lis s a ailable a ScienceDi ec
JSAMS Plus
jou nal homepage: www.jou nals.else ie .com/jsams-plus
h ps://doi.o g/10.1016/j.jsampl.2024.100068
Recei ed 19 Decembe 2023; Recei ed in e ised o m 23 May 2024; Accep ed 18 June 2024
2772-6967/©2024 The Au ho s. Published by Else ie L d on behal o Spo s Medicine Aus alia. This is an open access a icle unde he CC BY license (h p://
c ea i ecommons.o g/licenses/by/4.0/).
JSAMS Plus 4 (2024) 100068
P e ious esea ch in he 2010s examined he incidence o ice hockey
inju ies in se e al eli e-le el leagues and ou namen s a ound he wo ld.
Fo example, McKay e al. [6] documen ed an inju y incidence o 15.6
pe 1000 a hle e exposu es (AE) among NHL playe s, whe eas Tuominen
e al. [7] ound an inju y a e o 14.2 pe 1000 playe -games in he IIHF
Wo ld Championships. On he o he hand, B unne e al. [8] ecen ly
ound ime-loss inju ies o be as common as 88.6 pe 1000 playe -game
hou s in he highes -le el ice hockey league in Swi ze land, he Swiss
Na ional League (SNL). In all h ee s udies, body checking was docu-
men ed as he mos common mechanism o inju y [6–8]. McKay's [6] and
B unne 's [8] g oups ha e documen ed hip/g oin/ high egion and head
being inju ed mos commonly, whe eas Tuominen e al. [7] ha e e-
po ed head and ace as he mos commonly inju ed body pa . Concus-
sions ha e also been documen ed as common inju ies, accoun ing o
9.9% o inju ies in he IIHF ou namen s [7] and 18% in he SNL [8].
Howe e , he mos ecen epidemiological s udies conside ing Fin-
land's eli e-le el ice hockey inju ies a e om he 1990s [9,10]. O e he
las wo decades, ice hockey has unde gone significan changes and im-
p o emen s in e ms o he speed o he game and he quali y o he
equipmen . The sa e y o he inks has also imp o ed hanks o he
flexible boa ds ha a e compulso y in eli e-le el a enas in Finland.
Today, he men's highes -le el ice hockey league in Finland, Liiga, con-
sis s o 15 eams, each playing 60 games pe egula season. The numbe
o playe s in he squad is 22, and he size o he ice ink su ace is
compa able o he IIHF specifica ions [11]. Objec i e da a on
mode n-day ice hockey inju ies a e equi ed o imp o e playe sa e y.
The aim o he p esen esea ch was o measu e he inju y incidences
and desc ibe he de ails o he inju ies du ing he h ee seasons om
2017 o 2020 in Liiga. The cu en inju y a es we e also compa ed wi h
hose o p e ious s udies.
2. Ma e ials and me hods
The esea ch was conduc ed as a p ospec i e coho s udy. Ice hockey
inju ies we e egis e ed du ing he h ee seasons 2017–18, 2018–19, and
2019–20 in Liiga, he highes -le el ice hockey league in Finland. Only
inju ies occu ing du ing o ficial ma ches in he egula season and
playo s we e included. Each inju y was documen ed as an Inju y Repo
Sys em (IRS) o m in an elec ical da abase by he eams' heal hca e s a .
The IRS o ms eco ded a a ie y o inju y de ails, such as diagnosis, ype,
mechanism, se e i y, and possible penaliza ion. Inju ies we e diagnosed
by he eam physicians, while eam a hle ic aine s and physio he apis s
assis ed in documen ing he inju y epo s. The eams we e able o up-
da e he da a a e wa d. Be o e e e y season, a semina was held, whe e
he eams’heal hca e s a we e ins uc ed o use he IRS, and pe sonal
accoun s we e gi en o he sys em. The eams we e only able o access
hei own da a. All da a we e egis e ed wi h he pe mission o Liiga. All
analyses we e conduc ed anonymously.
An ice hockey inju y was defined by a s ic classifica ion compa able
o p e ious ice hockey s udies ha conside ed IIHF ou namen s [7]. A
combina ion o acu e inju ies ha equi ed medical a en ion o caused
ime loss was egis e ed. C i e ia o a ime-loss inju y we e me i he
playe was unable o con inue he game o missed he ollowing game o
p ac ice due o he inju y. T ea men in ol ing lace a ions and all den al
inju ies, concussions, and ac u es we e egis e ed. The inclusion
c i e ia we e also p esen ed in he web-based moni o ing sys em, whe e
he in o ma ion was collec ed. Inju ies no mee ing he inclusion c i e ia,
e.g., o e use inju ies (n ¼3) and illnesses (n ¼2), we e excluded.
The inju y incidence was p esen ed pe 1000 playe -games and pe
1000 playe -game hou s o acili a e compa isons wi h p e ious s udies
on ice hockey and o he spo s [4]. Each playe on he eam was a isk o
ge ing inju ed du ing he whole game, whe he on he ice o no . E en
on he subs i u es' bench, playe s can ge inju ed p epa ing o hei nex
shi . The e o e, ou es ima es o a hle e exposu e included all 22 eam
playe s in he denomina o . The inju y a e (IR) pe 1000 playe -game
hou s was calcula ed assuming ha bo h eams had fi e playe s and a
goalie playing on he ink o he whole 60 min o he game. Possible
o e ime and penal ies we e no conside ed in he o al exposu e ime.
A hle e exposu e (AE) was es ima ed based only on inju ies sus ained
du ing o ficial ma ches in he egula season and playo s. The numbe o
games was calcula ed by agg ega ing all he games played by e e y in-
di idual eam pa icipa ing in he esea ch. Hence, he numbe o eams
used in he o mula's di iso was one [7].
IR pe 1000 playe
game hou s ¼
#inju ies =#games
#playe s on he ice a he same ime *# eams*1000 games
IR pe 1000 playe
games ¼
#inju ies=#games
#playe s on he ice and bench *# eams*1000 games
To inc ease he da a alidi y and o e alua e he da a co e age, Game
Inju y Repo s (GIR) we e also comple ed on he same elec ical da abase
as he IRS o ms by he heal h ca e s a o he eam a e each ma ch. The
GIR o ms de ailed he numbe o inju ies sus ained in a single game and
we e comple ed e en i no inju ies had occu ed. The esea ch eam
emained in con ac wi h he eams o ensu e da a alidi y and o sol e
any possible p oblem si ua ions ha a ose.
The inju ies we e classified by ana omic egion, diagnosis, ype,
mechanism, penaliza ion, and se e i y. The p opo ional dis ibu ion o
inju ies and he es ima es o mean inju y a es we e calcula ed and
s udied using hese classifica ions. The inju ies and he mean inju y a es
we e also classified and examined by playe posi ion, game pe iod, and
ink zone. When analyzing he p opo ions o specific inju y de ails, in-
ju ies lacking his in o ma ion we e excluded om he single analysis.
3. Resul s
Inju ies we e collec ed o 1147 games by eigh indi idual eams: 341
games by fi e eams in he 2017–18 season, 393 games by six eams in he
2018–19 season, and 413 games by se en eams in he 2019–20 season.
In o al, 326 inju y epo s we e documen ed in 1147 games du ing
Liiga seasons 2017–2020. The a e age inju y a e (IR) was 12.9 pe 1000
playe -games and 47.4 pe 1000 playe -game hou s. The IR was he
highes du ing he 2019–2020 season (131 inju ies in 413 games; IR 14.4
pe 1000 playe -games) (Table 1).
The head and ace we e he mos commonly inju ed ana omical e-
gions, accoun ing o 36.2% o all inju ies (IR 4.7 pe 1000 playe -
games). Mos head and acial inju ies we e concussions (41.5%; IR
1.9), ollowed by lace a ions (27.1%) and con usions (16.1%). Facial
inju ies comp ised 20.6% o all inju ies, and occu ed mainly by a hi
om a s ick (43.3%) o a puck (26.9%). Den al inju ies, which accoun ed
o 8.9% o all inju ies (IR 1.1 pe 1000 playe -games), we e caused
mainly by a hi om a s ick (55.6%) o a puck (33.3%). Mou h gua d use
was epo ed in 63.2% o he den al inju ies. Eye inju ies we e all lac-
e a ions and accoun ed o 3.0% o he acial inju ies. A penal y was
called in only hal (48.1%) o he s ick-caused acial inju ies.
O all inju ies, 27.3% occu ed o he uppe ex emi y (IR 3.5 pe
1000 playe -games). The shoulde (IR 1.2) was in ol ed in 34.8% o
hese inju ies. In mos shoulde inju ies, he ac omiocla icula (AC) join
(45.2%) o glenohume al (GH) join (35.5%) was a ec ed. Shoulde in-
ju ies we e associa ed wi h body checking in 76.7% o he cases, and
61.3% we e ela ed o boa d con ac . Among he uppe ex emi y in-
ju ies, hand and finge (30,3%) inju ies we e also common, as well as
w is inju ies (18,0%). A hi by a puck was he mos common e iology o
he finge (50.0%) and hand inju ies (80.0%). Body checking (56.3%)
was he mos common eason o w is inju y.
Lowe ex emi y inju ies accoun ed o 25.8% (IR 3.3 pe 1000
playe -games) o he inju ies. Knee inju ies accoun ed o 47.6% o he
lowe ex emi y inju ies (IR 1.6 pe 1000 playe -games), ollowed by oo
(15.5%), ankle (9.5%), and high (9.5%). O he knee inju ies, medial
J. Hi el€
a e al. JSAMS Plus 4 (2024) 100068
2
colla e al ligamen (MCL) inju ies we e he mos ypical diagnoses
(51.6%). The an e io c ucia e ligamen (ACL) was a ely inju ed (6.5%).
No specific diagnosis was documen ed in 22.5% o he knee inju ies.
O e hal o he knee inju ies we e caused by body checking (54.1%).
Mos inju ies we e caused by body checking (31.5 %, IR 3.9 pe 1000
playe -games), a hi by a puck (19.7 %, IR 2.5), o a hi by a s ick (16,9 %,
IR 2.1) (Fig. 1). A g ea majo i y (97.8%) o he inju ies we e acu e in
na u e, and only 2.2% we e ecu en om he cu en o p e ious sea-
sons. The mos common inju y ypes we e con usions (29.3%), sp ains
(15.9%), and concussions (15.6%) (Fig. 2). Among con usion inju ies, a
hi by a puck was he mos common cause (46.2%), and he lowe body
(35.9%) was he mos commonly inju ed body pa .
The a e o concussion was 1.9 pe 1000 playe -games (7.1 pe 1000
playe -game hou s), accoun ing o 15.6% o he inju ies. O e hal o he
concussions occu ed due o a check o he head (34.7%) o a hi om
behind (16.3%) (Fig. 3). Mo eo e , no penal y was en o ced in 68.0%
(76.5% and 50.0%, espec i ely) o hese hi s leading o concussions. The
g ea es isk o a concussion a ose in he second pe iod (50.0%), ol-
lowed by he fi s pe iod (33.3%), and hen he hi d pe iod (16.7%). The
cen e playe s (24.5%) su e ed he mos concussions, ollowed by he
de ensemen (19.4% pe de enseman), he wings (14.3% pe wing), and
he goalies (8.2%).
A mino i y o he inju ies (29.7%, IR 3.7 pe 1000 playe -games) we e
ela ed o boa d con ac . Howe e , 61.3% o shoulde inju ies we e
ela ed o boa d con ac . In addi ion, 36.7% o he head inju ies and
34.2% o he knee inju ies we e caused by con ac wi h he boa ds.
Reco e y om inju y ook o e h ee weeks in 17.7% o he inju ies
(IR 2.1 pe 1000 playe -games) (Fig. 4). These inju ies we e mos
commonly consequences o body checking (34.7%) o being hi by a puck
(20.4%). Inju ies ela ed o a hi by a s ick (6.1%), a check o he head
(6.1%), o a check om behind (4.1%) seldom esul ed in o e h ee
weeks o ime loss. Knee (23.1%), hand and finge (21.2%), and shoulde
(13.5%) inju ies we e he mos equen ly inju ed body pa s esul ing in
o e 3 weeks o ime loss. An MCL inju y was diagnosed in 75 % o he
knee inju ies equi ing o e h ee weeks eco e y. In e ms o inju y
ypes, ac u es (30.8%), sp ains (26.9%), and s ains (21.2%) comp ised
mos o he inju ies equi ing mo e han h ee weeks o eco e y ime
(Fig. 5). Con usions (7.7%) and concussions (5.8%) ep esen ed a mi-
no i y o hese long-du a ion inju ies.
The cen e was he playe posi ion wi h he highes inju y incidence
(22.4%; IR 2.9 pe 1000 playe -games), compa ed o he wing (19.2%; IR
2.5) and he de enseman (18.4%; IR 2.4). The goalie was a ely inju ed
(2.5%, IR 0.3). The la ges p opo ion o he inju ies occu ed in he
second pe iod (40.9%), ollowed by he fi s (30.1%) and hi d (28.4%)
pe iods; howe e , his in o ma ion was lacking in app oxima ely a en h
o he cases. In o al, 262 ma ches (22.8%) wen o o e ime [12] and
0.7% o he inju ies occu ed du ing he o e ime pe iod. The la ges
p opo ion o inju ies occu ed in he de ensi e zone (46.0%), ollowed
by he o ensi e (40.0%) and he neu al (14.1%) zones.
4. Discussion
This esea ch examined he ice hockey inju y incidences and he de-
ails o he inju ies du ing h ee consecu i e seasons. Al oge he , 326 in-
ju ies we e documen ed in 1147 games, and he mean IR was 12.9 pe
1000 playe -games. The head and ace we e inju ed mos equen ly
(36.2%; IR 4.7), while knee (IR 1.6) and shoulde (IR 1.2) inju ies we e
also common. The ypical mechanism o inju y was body checking (31.5%;
Table 1
Numbe (n) and inju y a es (IR) o inju ies pe 1000 playe -games in o al and
annually.
Region To al 2017–2018 2018–2019 2019–2020
nIRnIRnIRnIR
Head & ace 118 4.7 33 4.4 43 5.0 42 4.6
Head 51 2.0 11 1.5 24 2.8 16 1.8
Face 34 1.3 10 1.3 8 0.9 16 1.8
Tee h 29 1.1 10 1.3 10 1.2 9 1.0
Eye 2 0.1 1 0.1 1 0.1 0 0
Ea 2 0.1 1 0.1 0 0 1 0.1
Uppe ex emi y 89 3.5 22 2.9 31 3.6 36 4.0
Shoulde 31 1.2 9 1.2 12 1.4 10 1.1
Hand 27 1.1 7 0.9 6 0.7 14 1.5
W is 16 0.6 1 0.1 10 1.2 5 0.6
Elbow 11 0.4 4 0.5 1 0.1 6 0.7
Fo ea m 4 0.2 1 0.1 2 0.2 1 0.1
Lowe ex emi y 84 3.3 25 3.3 25 2.9 34 3.7
Knee 40 1.6 13 1.7 11 1.3 16 1.8
Foo 15 0.6 4 0.5 7 0.8 4 0.4
Thigh 8 0.3 3 0.4 1 0.1 4 0.4
Ankle 8 0.3 2 0.3 4 0.5 2 0.2
Hip/G oin 7 0.3 1 0.1 1 0.1 5 0.6
Leg 6 0.2 2 0.3 1 0.1 3 0.3
O he 35 1.4 5 0.7 11 1.3 19 2.1
Abdomen 8 0.3 3 0.4 2 0.2 3 0.3
Ches 7 0.3 0 0.0 3 0.3 4 0.4
Neck 6 0.2 0 0.0 3 0.3 3 0.3
Lowe back 6 0.2 1 0.1 1 0.1 4 0.4
Pel is 5 0.2 0 0.0 2 0.2 3 0.3
Geni als 2 0.1 1 0.1 0 0.0 1 0.1
Th oa 1 0.0 0 0.0 0 0.0 1 0.1
To al 326 12.9 85 11.3 110 12.7 131 14.4
Fig. 1. The causes o he inju ies. In 3.8% o he cases, he cause o he inju y was unknown.
J. Hi el€
a e al. JSAMS Plus 4 (2024) 100068
3
IR 3.9), in ag eemen wi h he exis ing li e a u e [6–8]. The mos common
inju y ype was con usion (29.3%), while concussions (15.6%) we e also
sus ained equen ly. Rema kably, al hough hal o he concussions
occu ed ei he due o checking o he head o om behind,penal ies we e
called only in a mino i y (32.0%) o hese cases. Hi s by s icks caused mos
o he acial inju ies, and again, penal ies we e no called in 51.9% o he
s ick- ela ed acial inju ies. Nea ly one-fi h o all inju ies (17.7%; IR 2.1)
led o a ime loss g ea e han h ee weeks; hese we e mos ly ac u es,
sp ains, and s ains. The isk o inju y was highes in he second pe iod. O
all he playe s, he cen e s we e inju ed mos equen ly (22.4%).
Fig. 3. The mechanisms leading o concussions.
Fig. 2. Inju y ypes. In 3.8% o he inju ies, he inju y ype was unknown.
Fig. 4. The ime-loss o he inju ies (% o inju ies obse ed). In 10.1% o he cases, he se e i y o he inju y was unknown.
J. Hi el€
a e al. JSAMS Plus 4 (2024) 100068
4

The main s eng hs o his s udy we e he use o a web-based Inju y
Repo Sys em (IRS) o m and he adop ion o a compe en inju y defi-
ni ion ha has been u ilized p e iously in IIHF s udies since 2006 [7,13,
14]. In e ms o da a alidi y, he use o he Game Inju y Repo (GIR)
o ms imp o ed he co e age o he da a while p o iding an easy me hod
o es ima ing he ex en o unde - epo ed inju ies. The use o GIR o ms
also allowed he p o ision o eminde s o he eams i inju y epo s
we e missing.
The main limi a ion o he esea ch was ha no all he Liiga eams
pa icipa ed in he epo ing. Mo eo e , no simple ool was a ailable o
ensu e ha he eams we e consis en wi h epo ing and upda ing he
de ails o inju ies. Howe e , he inju y a es and ypes epo ed in his
s udy a e well in line wi h hose o p e ious s udies [6,7]. The e ec o
o e ime and penal ies on o al a hle e exposu e was no aken in o ac-
coun ; howe e , his had only a mino e ec on he numbe o o al
exposu e hou s. In addi ion, he inju y defini ion excluded inju ies ha
did no cause ime loss o equi e medical a en ion, ega dless o hei
po en ial e ec on he playe 's pe o mance. Acco ding o he consensus
s a emen by he IOC, he defini ion o inju y could be b oadened o
include any complain ha nega i ely a ec s a playe 's pe o mance [4].
Compa ed o p e ious s udies, he IR was sligh ly lowe han in men's
IIHF ou namen s (14.2 pe 1000 playe -games) and in he NHL (15.6 pe
1000 playe -games) [6,7]. Howe e , in he NHL, he season is longe , he
inks a e na owe , and ewe playe s comp ise he squad. In he IIHF
ou namen s, he inju y a e o shoulde (IR 1.7) and knee (IR 2.3) in-
ju ies was highe han in he p esen s udy (IR 1.2 and 1.6, espec i ely).
This di e ence may eflec a highe in ensi y and p essu e in he IIHF
games, as well as he comp ehensi e use o flexible boa ds in Liiga.
Compa ed o he o he s udies ha conside ed inju ies in he Finnish
Na ional League, conduc ed in he 1990s, he inju y a e was 28.2%
lowe in he p esen s udy [10]. This lowe inju y a e may ha e a isen
due o di e ences be ween he leagues, he e as, and he de elopmen o
he equipmen and he ules, as well as he sligh ly di e en s udy design
and he defini ion o inju y in he p esen s udy. Fu u e esea ch on ice
hockey inju ies is ad ised o use an IOC consensus on he defini ion o an
inju y and he inju y a e [4].
Concussions pe sis ed in equency, accoun ing o 15.6% o all ice
hockey inju ies (IR 1.9 pe 1000 playe -games and 7.1 pe 1000 playe -
game hou s). Tuominen e al. [7] ound an equi alen concussion a e o
men's WC- ou namen s (IR 1.9 pe 1000 playe -games), bu he ela i e
p opo ion o concussions was no iceably lowe in hei da a (9.9% o all
inju ies). Flik e al. [15] epo ed a game- ela ed p opo ion o concus-
sions o nea ly 23% o he inju ies among Ame ican college ice hockey
playe s. By con as , Donaldson e al. [16] epo ed a concussion a e o
only 0.52 pe 1000 playe -games in he NHL, whe eas Benson e al. [17]
p esen ed concussion densi y as 1.8 concussions pe 1000 playe -hou s in
he NHL. Compa ed o p e ious s udies in Finland in he 1990s, he
ela i e p opo ion o concussions has isen 3.3- old [10]. Howe e ,
oday, he diagnosis o concussions and b ain damage may be as e and
mo e accu a e due, o example, o he de elopmen o he unified
concussion p o ocol and he use o he Spo Concussion Assessmen Tool
[18,19]. Inc eased knowledge abou concussions may also ha e led o a
mo e cau ious app oach and leng hened playe 's ime loss om he game
a e a concussion.
Illegal hi s may be connec ed o highe measu es o head impac
se e i y compa ed o legal collisions [5]; consequen ly, hey a e equen
causes o inju ies. In his esea ch, a penal y was called in only 32.0% o
he concussions caused by checks o he head and checks om behind.
Thus, mo e accu a e ways o p e en inju ies should be pu sued. Wi h
mode n came a equipmen , each inju y si ua ion can be echecked om
ideos, and penal ies could be calledwi h he help o he o -ice o ficials. In
ou opinion, he heal h o playe s should be mo e impo an han he
smoo h flow o he game. Me hods o educe inju ies could also include
suspending playe s who accumula e nume ous penal ies du ing he season
[20] and p omo ing ai play and spo smanship mo e in ensi ely [21].
5. Conclusion
In his h ee-yea coho s udy in Liiga, he inju y a e (12.9 pe 1000
playe -games) was documen ed as sligh ly lowe han he a es epo ed in
p e ious s udies ha e alua ed NHL and IIHF ou namen s. The inju y a e
was also 28.2% lowe han in p e ious s udies conduc ed in Finland in he
1990s. The head and ace we e he body pa s inju ed he mos equen ly,
and body checking was he mos common mechanism o inju y. Concus-
sions pe sis ed as equen inju ies in eli e male ice hockey. O e hal o he
concussions occu ed due o an in ac ion. Reco e y ook o e h ee weeks
Fig. 5. The ime-loss caused by he di e en inju y ypes (% o inju ies obse ed). In 10.1% o he cases, he se e i y o he inju y was unknown.
J. Hi el€
a e al. JSAMS Plus 4 (2024) 100068
5
in 17.7% o he inju ies, which o mos we e knee, hand o shoulde in-
ju ies. In ac ions ha led o inju y we e penalized in only a mino i y o he
cases. Inju y moni o ing should be manda o y in all op-le el leagues o
imp o e he sho - e m and long- e m heal h o he playe s.
E hics app o al
As an anonymous egis e s udy, an e hics commi ee's e iew was no
needed acco ding o he c i e ia se by he Finnish Na ional Boa d o
Resea ch In eg i y TENK. All egis a ions and analyses we e made
anonymously.
Funding
Uni e si y o Jy €
askyl€
a has p o ided financial suppo o his
esea ch by paying he g amma check. Howe e , he unding o gani-
za ion did no ha e any ole in he collec ion o da a, hei analysis and
in e p e a ion, o in he igh o app o e o disapp o e publica ion o he
finished manusc ip .
Au ho ship
Jussi Hi el€
a, Ma kku Tuominen and Ja i Pa kka i concei ed and
designed he s udy. All au ho s ca ied ou da a collec ion and con ib-
u ed o in e p e a ion o he da a. Jussi Hi el€
a pe o med li e a u e
sea ch, da a analyses and w o e he fi s d a o he pape . All au ho s
e ised i c i ically and con ibu ed o he final manusc ip . All au ho s
ha e app o ed he submi ed e sion o he manusc ip and ag eed o be
accoun able o all aspec s o he wo k.
Decla a ion o compe ing in e es
None.
Acknowledgemen s
The au ho s since ely wan o hank each o he eam physicians and
heal h ca e s a membe s ha we e pa icipa ing olun a ily in his
s udy. The au ho s a e g a e ul o Olli Ikonen who aided wi h he s a-
is ics. The Uni e si y o Jy €
askyl€
a p o ided financial suppo o he
s udy by paying he g amma check. Finally, an acknowledgemen o
Liiga ha has suppo ed his s udy and inju y moni o ing o imp o e he
sa e y o he playe s in he u u e.
Appendix A. Supplemen a y da a
Supplemen a y da a o his a icle can be ound online a h ps
://doi.o g/10.1016/j.jsampl.2024.100068.
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Key poin s
In Finland, he inju y incidence among eli e male ice hockey
playe s has dec eased compa ed o he 1990s. Inju ies occu s ill
equen ly.
Head inju ies, especially concussions, pe sis o be equen
among eli e male ice hockey playe s.
Mos common inju y ypes equi ing o e h ee weeks eco e y
a e ac u es, s ains, and sp ains. Knee, hand (including finge s)
and shoulde inju ies comp ise mos o he long- e m inju ies.
J. Hi el€
a e al. JSAMS Plus 4 (2024) 100068
6