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Is Ice Hockey Too Dangerous? Correlation Between Head Injuries and Physical Play

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[i]This paper explores the problems in ice hockey such as concussions and other health risks linked to constant brain trauma. Looking at six published articles relating to concussions and the dangers at all levels of the sport. Castillo et al.’s (2017) talks about fighting with in the sport and how violence such as that can lead to more severe injuries. Kuhn & Solomon (2015) looks upon concussions in the National Hockey League, NHL. Leung (2017) reviews the risk of conclusions in Canadian youth hockey. Pollock (2019) tells the story of Todd Ewen a former professional hockey player who suffered from chronic traumatic encephalopathy, CTE. Tuomimen et al.’s (2017) look into concussions that occur during International Ice Hockey Federation (IIHF) World Championship (WC). While Vasilogambros (2016) sheds light on the NHL’s disbelief in CTE’s conection to multiple head trauma.

Keywords:  Concussion, NHL, CTE, IIHF, WC

Is Ice Hockey Too Dangerous? Correlation Between Head Injuries and Physical Play

There have been many recent studies discussing the injuries that players face in the sport of hockey. This comes with little surprise due to the fact that the game is played on 1/8-inch-thick steel blades at insane speeds. In the sport’s long history, it has grown and changed so much to a point in which never thought before and it keeps becoming more and more dangerous as the game gets faster.  In order to do so we need to take a look at some of the biggest safety issues surrounding the sport. Concussions and fighting go hand and hand, and while concussions can come in many different ways, we should look into the severity in both of these subjects and how they are related. The NHL is trying cover up the evidence of CTE as an injury that hockey players might develop due to fighting and head traumas.

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The participants were compiled on professional hockey players in the NHL and IIHF tournaments over 9 years (2006-2015). Other participants included 3,000 Canadian youth hockey players. The participants were not aware of the research due to the research being part of a played game and can not be predicted or preset.


The study analyzed Tuomimen et al.’s (2017) article. Which studied concussions using a standardized injury reporting system and diagnoses made by the team physicians.

Analyzed Pollock’s (2019) article on Todd Ewen and his playing career as an enforcer in the NHL as part of the study that links constant fighting and blows to the head with severe brain injuries such as CTE.


The study was conducted by taking the information about concussions given to us in Tuomimen et al.’s article, and comparing it to cases of players who have had major health issues during and after retirement.

Literature Review

One of the most threatening injuries in all contact sports today, are concussions. Hockey is no stranger when it comes to head injuries, although hockey leagues and officials try to protect the players as much as possible. Tuomimen et al.’s (2017) research article studies concussions in international hockey tournaments such as the Olympic Winter Games and International Ice Hockey Federation (IIHF) World Championship (WC), between 2006 & 2015.  A total of 3,293 games were played in the 169 tournaments by 1,212 teams (26,130 players) comprising 142,244 athletic game exposures (Tuomimen et al., 2017).  Concussions accounted for 10% of all injuries in the IIHF World Championships, including 160 concussions reported in the 3,293 games played throughout the nine-year study (Tuomimen et al., 2017). The article also studies the causes for concussions and put together a bar chart that shows us the which plays result in concussions more than others (See Figure 1). Sixty-six per cent of the concussions were caused by illegal contact. While the most common situation leading to concussion was contact with another player (89%). Concussions were caused mainly by CTH (42%), body checking (23%), checking from behind (13%) and unintended collision (UC) (13%) (Tuomimen et al., 2017). These numbers show the percentages of how often a concussion is caused by that action in IIHF and Olympic Games but these numbers differ in the NHL.

Kuhn & Solomon (2015) conducts research on concussions in the NHL since the beginning of the NHL-NHL Players Association Concussion Program in 1997. Kuhn & Solomon (2015) study the trends, incidence rates and underlying mechanisms of concussions. The rate of concussion in the NHL steadily grew more than tenfold from 1986–1987 to 2011–2012. The NHL implemented rule 48 prior to the 2010–2011 season which is a rule aimed to eliminate hits to the head as a defensive measure against concussions. While fewer concussions resulted from checks to the head, the total number of concussions continued to increase (Kuhn & Solomon, 2015).  During the 2006–2010 seasons, body checking with head contact made up 62.1% of concussions. In the 2009–2012 seasons, after the implementation of Rule 48, body checking without head contact (31.7%) made up the greatest proportion of concussions sustained in the NHL (Kuhn & Solomon, 2015). The rule may have lowered concussions due to head contact significantly, the incidence rate of concussion steadily rose from 2009–2010 to 2011–2012 (see figure 2). The increased prevalence of concussion appears to have not been tamed by rule changes and ongoing debate over fighting (Kuhn & Solomon, 2015). The NHL is trying to prevent concussions by creating awareness and implementing rules that don’t do what is fully intended.

Pollock (2019) shows the dangers of fighting and repeated head trauma, through the story of Todd Ewen. Ewen would play 11 seasons in the NHL, he would fight almost every game, sometimes more than once (Pollock 2019). After retiring, his family, especially his wife Kelli, noticed changes in his behavior. “We just saw some aggression that we hadn’t previously seen. Mood swings, irritability, and not sleeping. Just a pattern of things that was alarming to me.” Pollock (2019) quoted Ewen’s wife during an interview they had together, and also reviled that Ewen told Kelli that he feared he might have chronic traumatic encephalopathy (CTE). In 2013, 10 former players launched a class-action suit against the NHL for their negligence regarding head injuries. Todd was aware of the suit but declined to participate. He ended his life in the basement of his home on the afternoon of September 19, 2015 (Pollock 2019). Lili-Naz Hazrati tested Ewen’s brain and called with shocking results that Todd did not have the disease. The NHL seized on Hazrati’s negative diagnosis in its defense of the player’s ongoing head-injury class-action suit and in public statements by the league’s commissioner (Pollock 2019). Kelli Ewen repeatedly asked Hazrati to retest Todd’s brain but Hazrati declined. Eventually Kelli had sections of Todd’s brain sent from the Canadian Centre to Boston, where a world-leading expert on CTE, Ann McKee, could retest them. They later found that Todd did in fact have CTE (Pollock 2019).  The NHL looks like it is trying to deny and really push against the thought that CTE is caused by repetitive head trauma. Violence and physical contact are such a big part of the sport that the league is doing everything it can to try and protect the game itself rather than the players safety.

In 1922, the National Hockey League (NHL) introduced Rule 56 which made “fisticuffs” an official part of the game, which normalized and regulated fighting with in the game with little penalty (Castillo & Sommers, 2017).  Until 2004-2005, when the NHL locked out for a whole season they came to an agreement on a new rule when it came to fighting. Which states that a player who initiates a fight in the final five minutes of a game will receive a game misconduct and an automatic one-game suspension (Castillo et al., 2017). This rule came into place after it was noticed that fighting leads to even more dangerous behavior on the ice that might lead to catastrophic injuries. That is, severe penalties or game misconducts hold players accountable by reminding them there are consequences for their actions (Castillo et al., 2017). Fighting may be allowed in the NHL, but in the youth programs there is very little tolerance for fighting and there is no surprise to why that is. According to the USA Hockey rule (615a), “A major plus a game misconduct penalty shall be assessed to any player who engages in fighting. An additional minor penalty shall be assessed to any player who starts or instigates fighting.” A major penalty being five minutes and a minor penalty being two minutes. It doesn’t seem like much of a penalty but if that player is caught fighting again in that same season, they will be suspended 3 games, but if penalized for a third time for fighting the player will be suspended until they have a hearing with the proper authorities (USA Hockey 615[f]). It is clear that fighting is not something that we want our kids doing and the biggest reason being the high risk of injury. Fighting may be seen as a big part of the NHL and they have been trying to make it as safe as possible, but fighting is never truly safe.

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Vasilogambros (2016) puts together an article on concussions discussing if the NHL takes concussions as serious as they should. As we learn more and more about concussions and other brain traumatic injuries, it starts to be come evident that CTE is linked to consistent brain trauma, yet the NHL denies the science behind the claim. Dennis Vaske, a former player in the early 90s for the islanders, went into the boards head first and his helmet slid up causing him to become unconscious as his head leaved blood on the ice and into his skull. (Burnside, 2016). He now suffers from severe headaches and emotionally difficult moments, common side-effects of neurological damage. (Vasilogambros, 2016) Vasilogambros (2016) goes on to talk about a 2011 study from the Canadian Medical Association Journal. The study found that between 1997 and 2004, players sustained 559 concussions during the regular season, averaging 5.8 concussions per 100 players. The numbers have been on a constant incline which means that even though the NHL is implementing slight rule changes to try and reduce the concussions not enough is being done.

Hockey has become such a fast and skillful sport at all levels, more and more so every year, which means injury is sure to follow and youth hockey is no exception to this. According to a study done in by Leung (2017), written in a Canadian news source, Ontario and Alberta has had almost double the number of emergency-department visits for brain injuries from hockey than that from cycling, football and rugby, and skiing and snowboarding in 2014-15. A total of 2,929 hockey related head injuries occurred in the two provinces that year, mostly ranging from the ages of 10 to 14 (Leung 2017). Although the study takes place in Canada in which hockey is the national sport it still goes to show how serious the sport can be in terms of head injury. In 2012 the Canadian Pediatric Society called for youth hockey to eliminate body checking from non-elite programs. Instead Canada chose to raise the age requirement for checking to Bantams (13-14 years old) rather than Peewee (11-12 years old) (Leung, 2017). I have grown up playing hockey since I was five and when I was moving up an age group to what was supposed to be my first-year of checking. They changed the rule the year I became a peewee and replaced body checking with body contact. Body contact is the act of playing the puck rather than trying to hit  someone. You must have both hands on your stick and you are to battle it out using speed and skill rather than being overpowered with pure strength (USA Hockey Rule 604c). A study published earlier this year in the British Journal of Sports Medicine, by Dr. Emery, found a 64-per-cent reduction in the concussion rate of peewee-level hockey players after the rule change (Leung, 2017). The study based on youth hockey goes to show that hockey is an overall dangerous sport but without full contact the risk is lessened greatly while also giving relatively the same feel for the game.


  • Castillo, H. L., & Sommers, P. M. (2017, July 21). An Analysis of Fights in the National Hockey League. Retrieved from //
  • Kuhn, A. W., & Solomon, G. S. (2015, August 6). Concussion in the National Hockey League: A systematic review of the literature. Retrieved August 6, 2015, from //
  • Leung, W. (2017, November 12). When it comes to brain injuries, how dangerous is youth hockey? Retrieved from //
  • Pollock, N. (2019, April 25). The Tragic Post-Hockey Life of an NHL ‘Enforcer’. Retrieved from //
  • Tuominen, M., Hänninen, T., Parkkari, J., Stuart, M. J., Luoto, T., Kannus, P., & Aubry, M. (2017, February 01). Concussion in the international ice hockey World Championships and Olympic Winter Games between 2006 and 2015. Retrieved from //
  • USA Hockey (2017). Body Checking Rule 604 Retrieved from //
  • USA Hockey (2017). Fighting Rule 615. Retrieved from //
  • Vasilogambros, M. (2016, October 12). Does the NHL Take Concussions Seriously? Retrieved from //


Figure 1.Injury rates per 1000 player-games for causes of concussions.

Figure 2. Incidence rate of concussion in the National Hockey League: 1986–1987 through the 2011–2012 seasons.


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