Concussions in Youth Ice Hockey

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November 22nd, 2018 0 Comments

Catherine O’Brien

The brain is surrounded and protected by cerebrospinal fluid (CSF). A concussion occurs when the brain is knocked as a result of a blow to the head, quick acceleration or deceleration.

The Center for Disease Control and Prevention defines concussion as “a type of traumatic brain injury (TBI) caused by a bump, blow or jolt to the head or by a hit to the body that causes the head and brain to move rapidly back and forth” (CDC, Concussion, 2016).

A concussion is considered to be a minor brain injury but it should be taken seriously and treated immediately. Radhakrishnan et al. (2016) discuss concussion-related symptoms as falling into three primary categories.

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1. Somatic Symptoms

A headache, nausea, vomiting, extreme tiredness, and ringing in the ears etc.

2. Cognitive Symptoms

Difficulty paying attention and remembering, feeling slowed down or as if in a fog.

3. Affective Symptoms

Increased irritability, sadness, trouble sleeping, and anxiety.

*It is important to note that some symptoms may not present right away. It is best to air on the side of caution and seek medical help when you or someone you know has sustained a head injury.

In the review entitled The Era of Sports Concussion: Evolution of knowledge, practice and the role of psychology, Guay, Lebretore et al (2016) discuss key risk factors for concussion including participation in contact sports, previous injury and genetic factors, specifically the presence of apolipoprotein E (APOE) rare alleles.

This article will focus on the risk associated with contact sports. There is a specific study on the efficacy of measures being taken to decrease concussion incidence in youth hockey players.

The Good and The Bad

The Center for Disease Control and Prevention reported that while deaths resulting from traumatic brain injury (TBI) have declined, emergency department visits for TBI and concussion have increased from 2001 to 2010. According to the MayoClinic, being in contact sports greatly increases the chance for a concussion. Research led by Castile, Collins, Mcllvain, and Comstock (2011) confirmed this fact. They found that football, men’s and women’s soccer and women’s basketball saw the highest rates of concussion in a study of high school athletes (Castile et al. 2011).

While ice hockey is not the highest when it comes to sports-related concussion, the risk of concussion is still very real for ice hockey players. Studies by Izraelski, J. (2014) estimated that concussions account for between 2-14% of all hockey injuries and between 15-30% of all hockey head injuries. In addition, statistics provided by USA Hockey and Hockey Canada indicate that participation in ice hockey is increasing year over year. As such, it is no surprise that concussions in youth hockey players are being investigated.

Zero Tolerance for Head Contact

youth-hockeyKrolikowski et al. examined the impact of the “Zero Tolerance for Head Contact” rule in youth hockey and whether this rule was successful. The rule was put in place following the nationwide adoption of a rule which delayed body checking in youth hockey games. Body checking is now only allowed when players are 13 years or older. According to work referenced by Krolikowski et al (2017), body checking is a leading cause of concussion in the sport. Not allowing it for Pee Wee teams had positive effects in reducing concussion among this population of players.

The “Zero Tolerance Head Contact” rule, also known as rule 6.5, was enacted in 2011 with the intention of reducing the incidence of concussion and similar injuries in youth hockey. The rule penalizes players for any intentional or unintentional contact above the shoulders. The goal of the retrospective study was to examine if Pee Wee (11-12 years old) and Bantam (13-14 years old) hockey players had a reduced incidence of concussion following the implementation of rule 6.5.

This retrospective study gathered data from Pee Wee teams and Bantam Teams pre and post implementation of rule 6.5. Various data points were collected on each of the 2,099 Pee Wee and Bantam players. It includes prior medical history (pre-season), daily hockey participation and concussion data.

Injury Reports

Injury reports were filed for every injury that happened and reports were validated by an athletic or physical therapist. The reports included details about the injury including the source of the injury, events around the injury and the process involved.  For example, was the injury caused by head to head contact, contact with the boards, contact with the ice or puck etc. The study differentiated between game-related concussions and more severe-game related concussions where severe concussions were defined as causing > 10-day time loss.

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The Results

Unfortunately, results indicated an increased incidence of concussion in Pee Wee and Bantam youth hockey following the implementation of rule 6.5. Furthermore, a greater percentage of concussions sustained in the post rule period were classified as severe. It suggests that players were at a greater risk for a concussion following the implementation of the rule compared to before.

Of course, the study does consider some extraneous factors that could be a source of these results. For example, it is possible that with the increased attention and concern surrounding concussion in youth sport, more concussions were reported and diagnosed in the more recent seasons compared to the pre-rule seasons.


In conclusion, the results of Krolikowski’s study are slightly disheartening but we cannot say for sure that the implementation of the rule caused an increased concussion. Rather, as they point out, there are other factors at play that could have caused these results. Sports-related concussions are a serious problem in sports at all levels. Therefore, rules should continue to be put in place and tested in order to improve outcomes for players.

It is the responsibility of the athletic and scientific community to continue to monitor and test the efficacy of these rules. We need an effective solution and a decrease in the incidence of sports-related concussions.


Guay, J.L., Lebretore, B.M., Main, J.M. et al. (2016) The era of sports concussion: Evolution of knowledge, practice and the role of psychology. American Psychologist, 71(9), 875-887.

Izeaelski, J. (2014) Concussions in the NHL: A narrative review of the literature. The Journal of the Canadian Chiropractic Association, 58(4).

Krolikowski, M.P., Black, A.M., Palacios-Derflingher, L., et al. (2017) The effect of the “Zero Tolerance for Head Contact”. Rule change on the risk of concussions in youth ice hockey players. The American Journal of Sports Medicine, 45(2), 468-473.

Radhakrishnan, R., Carakani, A., Gross, L, et al. (2016) Neuropsychiatric aspects of a concussion. Lancet Psychiatry, 3, 1166-75.

Centers for Disease Control and Prevention (2016). Traumatic Brain Injury & Concussion. Retrieved February 16, 2017, from &

The Mayo Clinic (2016) Concussion: Symptoms and causes. Retrieved February 16, 2017, from

The United States of Hockey (2014). U.S Hockey Participation Numbers for 2013-14. Retrieved February 16, 2017, from

Hockey Canada (2017). Statistics and history. Retrieved on February 16, 2017 from

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