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Heal h Psychology and Beha io al Medicine
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The p e alence o musculoskele al pain and use
o painkille s among adolescen male ice hockey
playe s in Finland
Ha i Selanne, Ta iana V. Ryba, Ki s i Siekkinen, Heikki Ky öläinen, Hannu
Kau iainen, Ha o Hakonen, Ma ja Mikkelsson & U ho M. Kujala
To ci e his a icle: Ha i Selanne, Ta iana V. Ryba, Ki s i Siekkinen, Heikki Ky öläinen,
Hannu Kau iainen, Ha o Hakonen, Ma ja Mikkelsson & U ho M. Kujala (2014) The
p e alence o musculoskele al pain and use o painkille s among adolescen male ice
hockey playe s in Finland, Heal h Psychology and Beha io al Medicine, 2:1, 448-454, DOI:
10.1080/21642850.2014.884463
To link o his a icle: h p://dx.doi.o g/10.1080/21642850.2014.884463
© 2014 The Au ho (s). Published by Taylo &
F ancis.
Published online: 15 Ap 2014.
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The p e alence o musculoskele al pain and use o painkille s among
adolescen male ice hockey playe s in Finland
Ha i Selanne
a
*, Ta iana V. Ryba
b
, Ki s i Siekkinen
a
, Heikki Ky öläinen
c
, Hannu Kau iainen
d
,
Ha o Hakonen
a
, Ma ja Mikkelsson
e
and U ho M. Kujala
a
LIKES Resea ch Cen e , Jy äskylä, Finland;
b
Ins i u e o Spo s Science and Clinical Biomechanics,
Uni e si y o Sou he n Denma k, Odense, Denma k;
c
Depa men o Biology o Physical Ac i i y, Uni e si y
o Jy äskylä, Jy äskylä, Finland;
d
Med Ca e Oy, Äänekoski, Finland;
e
Päijä -Häme Social and Heal h Ca e
G oup, Lah i, Finland;
Depa men o Heal h Sciences, Uni e si y o Jy äskylä, Jy äskylä, Finland
(Recei ed 20 No embe 2013; accep ed 14 Janua y 2014)
Pa icipa ing in compe i i e spo inc eases he isk o inju ies and musculoskele al pain
among adolescen a hle es. The e is also e idence ha he use o p esc ip ion d ugs has
inc eased among spo club a hle es. The pu pose o his s udy was o e alua e he use o
painkille s among young male ice hockey playe s (IHP) in compa ison o schoolboys
(con ols) and i s ela ion o he p e alence o musculoskele al pain and p oblems du ing
ac i i ies and sleeping. In o ma ion was ga he ed h ough a ques ionnai e, comple ed by 121
IHP and compa ed o he esponses o 618 age-ma ched con ols. Resul s showed ha
mon hly exis ing pain was a 82% o IHP, and 72% o con ols, hough IHP had
s a is ically mo e musculoskele al pain in hei lowe limbs (56% s. 44%), lowe back
(54% s. 35%), and bu ocks (26% s. 11%). The e we e no g oup di e ences in he neck,
uppe back, uppe limb, o ches a eas. The disabili y index was s a is ically simila o bo h
g oups, as musculoskele al pain causing di ficul ies in daily ac i i ies and sleeping was
epo ed by a mino i y o subjec s. Despi e his simila i y, IHP used mo e painkille s han
con ols (18% s. 10%). Fu he nuanced esea ch is encou aged o compa e a hle es and
non-a hle es in ela ion o painkille s.
Keywo ds: musculoskele al pain; painkille s; adolescen a hle es; inju y and p e en ion
In oduc ion
Spo pa icipa ion is a highly alued social ac i i y in Eu ope (Eu opean Commission, 2007). In
Finland, o example, 24% o he popula ion iden i y hemsel es as a hle es and pa en s in ol e
hei child en in o ganized spo s a inc easingly ea lie ages (SLU, 2010). Despi e nume ous
psychological, social, and heal h benefi s o spo pa icipa ion, esea che s ha e also iden ified
he inc eased isk o inju ies and musculoskele al pain among adolescen a hle es (Au inen,
Tammelin, Taimela, Zi ing, & Ka ppinen, 2008; Kujala, Taimela, & Viljanen, 1999).
Ice hockey is he mos popula spo among male you h in Finland. Du ing in ensi e aining
pe iods, he lowe back, pel ic egion and lowe limbs o ice hockey playe s (IHP) a e exposed o
high loading. Du ing ma ches, equen con ac a high speeds wi h each o he and he boa ds
(body checking) c ea e a conside able isk o sus aining uppe limb and uppe body inju ies
© 2014 The Au ho (s). Published by Taylo & F ancis
*Co esponding au ho . Email: ha i.selanne@likes.fi
This is an open-access a icle dis ibu ed unde he e ms o he C ea i e Commons A ibu ion License h p://c ea i ecommons.o g/
licenses/by/3.0/, which pe mi s un es ic ed use, dis ibu ion, and ep oduc ion in any medium, p o ided he o iginal wo k is p ope ly
ci ed. The mo al igh s o he named au ho (s) ha e been asse ed.
Heal h Psychology & Beha iou al Medicine, 2014
Vol. 2, No. 1, 448–454, h p://dx.doi.o g/10.1080/21642850.2014.884463
and musculoskele al pain (Mölsä, Kujala, Näsman, Leh ipuu, & Ai aksinen, 2000; Sim, Simone ,
Mel on, & Lehn, 1987). While se e al epo s ha e been published on inju ies among playe s o
di e en ages and di isions in ice hockey, li le is known abou he p e alence o musculoskele al
pain among adolescen male IHP (Benson & Meeuwisse, 2005; Eme y & Meeuwisse, 2006;
Kujala e al., 1995).
The e is also limi ed da a abou he use o painkille s among adolescen playe s. Wa ne ,
Schnep , Ba e , Donald, and Swigonski (2002) ound ha among adolescen high school oo -
ball playe s, one ou o se en playe s ake non-s e oidal an i-inflamma o y d ugs (NSAIDs) on a
daily basis. Kelly and Pa sons (2007) u he epo ed on he inc eased use o p esc ip ion d ugs
among young a hle es in spo clubs. Being key si es o social li e among you h, spo clubs
appea o endo se he use o painkille s a he han a b eak in aining o ea musculoskele al
pain. Howe e , he use o NSAIDs is beneficial only in so issue inflamma o y pa hologies,
such as enosyno i is and impingemen , bu no ac u es, ch onic endinopa hies o muscle inju-
ies (Paoloni, Milne, O cha d, & Hamil on, 2009). The unheal hy influence o painkille s on gas-
oin es inal and kidney unc ion as well as on ca ilage is well documen ed (K is ensen e al.,
2012; Wa e man & Kapu , 2012) wi h a possibili y o some a e bu e y dange ous side
e ec s in li e unc ions (Lapey e-Mes e e al., 2006). I has also been sugges ed ha
NSAIDs can cause mal unc ion o he muscle me abolism and, he e o e, can be e y ha m ul
o young a hle es’physical de elopmen (Mackey, 2007).
Consequen ly, he pu pose o his s udy was o e alua e he p e alence o musculoskele al pain
and use o painkille s among adolescen , na ional-le el, male IHP compa ed o age-ma ched
schoolboys (con ols). Fu he , we s udied he influence o he pain on ce ain daily ac i i ies
and sleeping diso de s. The ollowing esea ch ques ions guided he s udy: (1) wha is he p e a-
lence o musculoskele al pain among adolescen male IHP in Finland? (2) wha is he e ec o
he pain on you h’s e e yday li e? and (3) wha is he IHP usage o painkille s compa ed o con ols?
Me hods
Pa icipan s
The e hics commi ee o he Cen al Finland Heal h Ca e Dis ic app o ed he s udy. Be o e he
s udy, w i en consen was ob ained om he pa en s o 121 young male na ional-le el IHP in
Finland (M
age
= 15 yea s, R
age
=14–16 yea s). IHP answe ed a ques ionnai e (desc ibed below)
be o e he beginning o a na ional ice hockey se ies. Du ing his pe iod, he playe s ain in en-
si ely and pa icipa e in some p ac ice ma ches. Thei esponses we e compa ed o 618 age-
ma ched schoolboys (con ols), who had answe ed he same ques ionnai e. The mean age, age
dis ibu ion and esponse a e (93%) was simila in bo h g oups.
Ques ionnai e
The ques ionnai e included i ems on he p e alence o pain in he neck, uppe and lowe ex emi-
ies, uppe and lowe back, bu ocks and ches a ea ha had occu ed a leas once a mon h du ing
he p e ious h ee mon hs. Simila scales ha e been used in he esea ch o Mikkelsson, Salminen,
and Kau iainen (1996,1997). Ques ions we e also asked on he use o pain kille s o ea he
epo ed pain, and he esponden s’es ima es o he e ec s o his pain on a ious daily ac i i ies,
such as walking mo e han one kilome e , si ing du ing lessons a school, pa icipa ing in school
physical educa ion, engaging in hobbies, and also on abili y o all asleep o sleeping.
A disabili y sum index, as desc ibed by Mikkelsson e al. (1997), was calcula ed om he
answe s o he ollowing s a emen s: (1) I ha e di ficul y in alling asleep because o pain and
aches and/o pain and aches in e e e wi h my sleep; (2) I ha e di ficul y in si ing du ing a
Heal h Psychology & Beha io al Medicine 449
lesson; (3) pain bo he s me i I walk mo e han one kilome e ; (4) pain bo he s me du ing physical
educa ion class; and (5) pain and aches in e e e wi h my hobbies.
S a is ical analysis
Resul s we e exp essed as means wi h s anda d de ia ion o equency coun s wi h pe cen age
coun s. In e -g oup s a is ical compa isons we e pe o med by chi-squa e es o a pe mu a ion
es –as app op ia e. The αle el was se a 0.05 o all es s.
Resul s
Musculoskele al pain occu ing a leas once a mon h was epo ed by 82% o he IHP compa ed
o 72% o con ols (p= .030). The p e alence o pain in he lowe limbs (56% s. 44%; p= .017),
low back (54% s. 35%; p< .001) and bu ocks (26% s. 11%; p< .001) was highe among IHP
han con ols. The e we e no s a is ically significan di e ences in he p e alence o pain in he
neck (44% s. 48%; p= .37), uppe back (31% s. 29%; p= .57), uppe limbs (26% s. 28%;
p= .02) o ches a eas (15% s. 18%; p= .33) be ween he s udy g oups (Figu e 1). Only a min-
o i y o he esponden s in bo h g oups epo ed di ficul ies in daily ac i i ies and sleeping caused
by musculoskele al pain. These pain-induced p oblems we e o med in o a disabili y index, which
was s a is ically simila o bo h g oups (IHP s. con ols; 0.40 ± 0.92 s. 0.47 ± 0.93; p= .43 by
pe mu a ion es ). The composi e measu es o he disabili y index a e shown in Table 1. The
esul s ob ained u he e ealed ha he use o painkille s by IHP was significan ly highe
han con ols (18% s. 10%; p= .008).
Discussion
The p esen s udy’s esul s sugges ha male adolescen IHP in Finland expe ience musculoske-
le al pain a leas once a mon h du ing an in ensi e aining p e-compe i ion pe iod. Compa ed o
Figu e 1. Pe cei ed pain in musculoskele al sys em in IHP and con ols (*p< .05, **p< .01, ***p< .001).
450 H. Selanne e al.
he age-ma ched con ols, IHP had mo e o e all musculoskele al pain, especially in hei lowe
limbs, low back, and bu ocks a eas. The e we e no significan di e ences in he neck, uppe
ex emi ies, uppe back o ches pain be ween hese s udy g oups. The disabili y index caused
by musculoskele al pain was simila in bo h s udy g oups, bu ega dless o ha IHP used con-
side ably mo e painkille s han hei age-ma ched con ols.
Musculoskele al pain
The p e alence o musculoskele al pain among adolescen s a ies in p e ious s udies acco ding
o he age o subjec s, pain loca ion and he ime pe iod used. To ou knowledge, he e a e no
s udies abou male adolescen IHPs’musculoskele al pain. Acco ding o he p esen s udy, he
IHP seem o ha e mo e o e all musculoskele al pain han he con ols, which is an expec ed
esul conside ing he na u e o ice hockey as a con ac collision spo wi h high speed and
high impac s.
In p e ious s udies i has been shown ha low back and neck a eas a e he mos common ana-
omical loca ion o musculoskele al pain in he adolescen popula ion (Hakala, Rimpelä, Salmi-
nen, Vi anen, & Rimpelä, 2002; Kujala, Taimela, E kin alo, Salminen, & Kap io, 1996).
When compa ing “spo s g oup”wi h “no spo s g oup”, Sa o e al. (2011) ha e indica ed ha
he li e- ime p e alence o low back pain was significan ly highe in he “spo s g oup”popula ion
o Japanese child en and adolescen s. I has been u he acknowledged ha igo ous pa ici-
pa ion in physical ac i i ies is ela ed o he sel - epo ed low back pain (Au inen e al., 2008;
Kujala e al., 1999). Ano he s udy o 4667 Japanese s uden s epo ed ha excessi e exposu e
o compe i i e spo s ac i i ies du ing you h is associa ed wi h low back pain, and also symp oms
in he lowe ex emi ies a ied in di e en spo disciplines (Hangai e al., 2010).
In he p esen s udy, IHP epo ed mo e pain in he lowe limb, low back, and bu ocks a eas
han he con ols, wi h a significan ly highe pe cen age o mon hly exis ing low back pain (54%).
In addi ion o he inc ease in low back pain om pa icipa ion in compe i i e a hle ics, he
demands o a specific spo a ec he musculoskele al pain expe ienced by an adolescen . In
ice hockey, main aining ska ing posi ion loads he low back, and may he e o e cause low
back pain. Fu he mo e, a he age o 14–16 ( his s udy’s pa icipan s), aining equency and
in ensi y inc ease while he musculoskele al sys em o male playe s is s ill no ully de eloped.
All hese ac o s can lead o inc eased loading o he unk and lowe limb a eas.
I is in e es ing ha in his s udy, IHP did no ha e mo e musculoskele al pain in hei ches ,
uppe back, uppe limb o neck a ea han con ols. This cohe es wi h he findings o Feldman,
Sh ie , Rossignol, and Lucien (2002) who concluded ha , al hough neck and uppe limb pain
is common among eenage s, spo in ol emen does no c ea e a isk ac o o he de elopmen
o his ype o pain. The ac ha ou ques ionnai e was adminis a ed be o e he compe i ion
Table 1. Absolu e and ela i e dis ibu ion o di e en daily ac i i ies and sleeping diso de s among IHP
and con ols.
Disabili y index i ems: di ficul ies caused by
musculoskele al pain
Ice hockey N
(%)
Con ols N
(%) P- alue
Falling asleep 4 (3) 33 (5) 0.35
Sleeping diso de s 2 (2) 23 (4) 0.25
Si ing du ing school lessons 12 (10) 56 (9) 0.77
Walking mo e han 1 km 6 (5) 51 (8) 0.21
Pa icipa ing in school physical educa ion 13 (11) 62 (10) 0.81
Fulfilling ee- ime hobbies 11 (9) 68 (11) 0.53
Heal h Psychology & Beha io al Medicine 451

pe iod migh ha e con ibu ed o he low p e alence indices o musculoskele al pain in he uppe
body and uppe limbs among IHP compa ed o con ols. The hea y aining du ing summe
causes ex a loading, especially o lowe ana omical a eas o he body, while he igo ous
playing and c oss checking du ing games end o a ec mo e uppe body a eas. Mo eo e ,
egula s eng h and condi ioning aining in ice hockey migh ha e p o ec ed, o some ex en ,
he ice hockey esponden s om uppe body pain and ache, because s eng h aining has been
es ablished o be a p e en i e measu e om neck and shoulde pain (Ylinen, Häkkinen,
Nykänen, Kau iainen, & Takala, 2007).
The use o painkille s and p oblems in daily ac i i ies caused by pain
Resul s ob ained in his s udy sugges ha musculoskele al pain dis u bed sligh ly such daily
ac i i ies as walking mo e han one kilome e , si ing du ing school lessons, pa icipa ing in
school physical educa ion, ulfilling leisu e ime hobbies, alling asleep o sleeping in bo h
s udy g oups. The e was no s a is ical di e ence in hese p oblems be ween he g oups. Ne e -
heless he amoun o painkille s used by IHP was wice as common as among he con ols.
The e may be some benefi s in ea ing inflamma o y p ocesses o he body wi h painkille s,
especially wi h NSAIDs, bu he e may also be side e ec s.
Acco ding o Kelly and Pa son’s(2007) epo o he ala ming inc ease in he usage o p e-
sc ip ion d ugs among young spo club a hle es, he e is a dange ha painkille s a e dis ibu ed
o young a hle es by coaching s a o p e en po en ial pain (and no o eal need) leading o
misuse o painkille s in a spo club se ing. Fu he mo e, dominan na a i es in he ice
hockey cul u e, such as “only eal men play hockey”and “no pain, no gain”, con ibu e o no mal-
izing pain as necessa y in a hle ic pu sui s. Thus, adolescen hockey playe s become p one o
aking painkille s in o de o ain and pa icipa e in ma ches ins ead o aking a b eak due o mus-
culoskele al pain o inju y. Such desensi iza ion o painkille s ha enable young a hle es o ain
and pe o m be e migh be implica ed in he de eloping o a “doping men ali y”(Melze , Elbe,
& B and, 2010), becoming a ga eway o he use o o bidden pe o mance enhancemen
subs ances.
Regula use o painkille s is known o cause undesi ed e ec s on s omach, li e and kidney
unc ions, and on he me abolism in ca ilage issue (K is ensen e al., 2012; Lapey e-Mes e e al.,
2006; Redéen, Pe e sson, Kechagias, Må dh, & Bo ch, 2010; Wa e man & Kapu , 2012).
Bodensen, Mill, Kegley, and Pa la h (2004) ha e u he iden ified ha NSAIDs ha e a nega i e
influence on skele al muscle myogenesis h ough cyclo-oxygenase pa hway. The e o e, coaching
s a and pa en s should exe cise easonable cau ion when adminis e ing painkille s o young a h-
le es and ins ead educa e a hle es abou heal hie means o ea ing musculoskele al pain, such as
cold packs and es om aining o acili a e he eco e y. Fu he s udies a e needed o in es i-
ga e exac indica ions o he use o painkille s among adolescen a hle es.
Limi a ions o he s udy
In his esea ch, esponden s answe ed ques ions abou musculoskele al pain and use o pain-
kille s e ospec i ely. Recall bias is a known limi a ion o e ospec i e ques ionnai e s udies.
In addi ion, ice hockey is a high collision spo , exposing he a hle es o egula con ac s and con-
usions, which may ha e con ibu ed o IHP’s di e gen in e p e a ions o pain han con ols. A
he age o he p esen s udy g oups (14–16 yea s), some o he pa icipan s migh s ill ha e g ow h
pain, influencing he esul s ob ained. Due o he ac ha only male playe s pa icipa ed in he
esea ch, conclusions conce ning he e ec o gende on he esul s canno be made.
452 H. Selanne e al.
Conclusion
Though musculoskele al pain is mo e common in compe i i e adolescen IHP han in hei pee s,
he e is no significan di e ence in he neck, uppe back, uppe limb, o ches a ea pain epo ed
by bo h g oups. Howe e , he adolescen IHP do demons a e a highe pe cen age o musculos-
kele al pain in he a eas o he low back, bu ocks, and lowe limbs han age-ma ched con ols.
In bo h g oups, a mino i y epo ed some di ficul y in pe o ming daily ac i i ies and a dis-
u bance in sleeping as a esul o musculoskele al pain. The in ensi y o his pain is no high,
bu in con as wi h he con ols, IHP epo using a highe pe cen age o painkille s o diminish
hese e ec s. This aises he ques ion o whe he IHP a e ecei ing he app op ia e dosage o pain-
kille s, co esponding o hei le el o musculoskele al pain, and, indeed, wha is he bes way o
ea his pain acco ding o good clinical p ac ice.
Fu he nuanced esea ch is necessa y o de e mine whe he he simila le els o musculoske-
le al pain epo ed by IHP and con ols is as a esul o o despi e he dispa a e usage o painkille s.
The e is u he need o es ablish whe he adolescen a hle es a e being gi en and a e aking p e-
sc ip ion painkille s in a manne app op ia e o hei inju ies and epo ed pain, o whe he he
dispa i y be ween painkille usage be ween IHP and con ols e eals a misuse o hese esou ces.
Fu he s udies could also in es iga e he e ec o gende on sel - epo ed pain and usage o pain-
kille s in ice hockey and o he spo s.
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