Epidemiology of Traumatic and Overuse Injuries in Swiss Professional Male Ice Hockey Players

Abstract

Background
Ice hockey injury patterns in Europe were last evaluated in the 1990s.

Purpose
The aim of this study was to assess the frequency, type, location, and incidence of traumatic injuries, as well as the prevalence and relative effect of overuse injuries in professional male ice hockey players.

Study Design
Descriptive epidemiology study.

Methods
Traumatic injuries were assessed using a standardized injury report form over a 1-year period (including the preparatory phase and season). The Oslo Sports Trauma Research Centre Overuse Injury Questionnaire was used to determine overall and substantial overuse injuries and their relative effect on ice hockey players.

Results
Five Swiss National League teams participated in the study. From a total of 321 recorded injuries, 179 led to time loss from sport. The game-related time-loss injury incidence during the season was 88.6/1000 player-game hours.Time-loss injuries affected mainly the hip/groin/thigh region (23%), followed by the head (17%). Most time-loss injuries were classified as muscle strains (24%), followed by concussions (18%). The most common injury mechanism involved collision with an opponent’s body (31%), and right forward players (23%) were most likely to report a game-related injury. Most injuries (27%) occurred within the defending zone along the boards. The average prevalence rates of all overuse and substantial overuse injuries were 49% and 13%, respectively. The hip/groin displayed the highest average prevalence for all overuse problems (16%), translating to the highest relative effect.

Conclusion
Muscle strains and concussions were the most frequent time-loss injuries in Swiss professional ice hockey players. The hip/groin was the most affected region for both traumatic and overuse injuries.

Full text

Original Research
Epidemiology of Traumatic and Overuse Injuries
in Swiss Professional Male Ice Hockey Players
Romana Brunner,*
†
MSc, PT, Mario Bizzini,
†
PhD, PT, Karin Niedermann,
‡
PhD, PT,
and Nicola A. Maffiuletti,
†
PhD
Investigation performed at the Human Performance Lab, Schulthess Clinic, Zurich, Switzerland
Background: Ice hockey injury patterns in Europe were last evaluated in the 1990s.
Purpose: The aim of this study was to assess the frequency, type, location, and incidence of traumatic injuries, as well as the
prevalence and relative effect of overuse injuries in professional male ice hockey players.
Study Design: Descriptive epidemiology study.
Methods: Traumatic injuries were assessed using a standardized injury report form over a 1-year period (including the preparatory
phase and season). The Oslo Sports Trauma Research Centre Overuse Injury Questionnaire was used to determine overall and
substantial overuse injuries and their relative effect on ice hockey players.
Results: Five Swiss National League teams participated in the study. From a total of 321 recorded injuries, 179 led to time loss from
sport. The game-related time-loss injury incidence during the season was 88.6/1000 player-game hours.Time-loss injuries affected
mainly the hip/groin/thigh region (23%), followed by the head (17%). Most time-loss injuries were classified as muscle strains (24%),
followed by concussions (18%). The most common injury mechanism involved collision with an opponent’s body (31%), and right
forward players (23%) were most likely to report a game-related injury. Most injuries (27%) occurred within the defending zone along
the boards. The average prevalence rates of all overuse and substantial overuse injuries were 49% and 13%, respectively. The hip/
groin displayed the highest average prevalence for all overuse problems (16%), translating to the highest relative effect.
Conclusion: Muscle strains and concussions were the most frequent time-loss injuries in Swiss professional ice hockey players.
The hip/groin was the most affected region for both traumatic and overuse injuries.
Keywords: traumatic injuries; overuse injuries; epidemiology; ice hockey
Ice hockey is a popular high-impact sport, especially in
North America and northern Europe. A number of injury
risk factors, including high velocity on the ice, unintended
collisions, rapid changes in direction, and injuries from the
board, puck, and sticks, lead to a high risk of a wide variety
of player injuries.
24,27
Injuries can be categorized as a
result of either a traumatic event (ie, a condition caused
by an identifiable single external transfer of energy, such
as a collision leading to bone fractures) or overuse (ie, there
is no identifiable single external transfer of energy, but the
condition is caused by multiple accumulative bouts of
energy transfer, such as multiple microtraumas leading
to, for example, tendon tears).
26
Depending on the surveil-
lance methods used, the overall injury incidence in colle-
giate and professional men’s ice hockey currently ranges
from 4.9 to 15.6 per 1000 athlete-exposures, with approxi-
mately 50 injuries per 1000 player-game hours.
11,20,27
Ice hockey injury patterns in Europe were last evaluated
in the 1990s
19,21-23
; however, they may have changed over
the past 2 decades as a result of increased player speed and
aggressiveness.
3,11
Most traumatic injuries in previous
investigations occurred at the head and face, followed by
the thigh and knee region.
20,27
On the other hand, the most
common types of overuse injuries mainly affected the groin,
followed by the shoulder, elbow, and wrist region.
23
Applying different surveillance methods and injury defi-
nitions has often led to reporting discrepancies in the fre-
quency and type of both traumatic and overuse injuries.
20
*Address correspondence to Romana Brunner, MSc, PT, Human
Performance Lab, Schulthess Clinic, Lengghalde 6, CH-8008 Zurich,
Switzerland (email: romana.brunner@kws.ch).
†
Human Performance Lab, Schulthess Clinic, Zurich, Switzerland.
‡
Zurich University of Applied Sciences, School of Health Professions,
Institute of Physiotherapy, Winterthur, Switzerland.
Final revision submitted April 1, 2020; accepted April 21, 2020.
One or more of the authors has declared the following potential con-
flict of interest or source of funding: This study was supported in part by
the Zurich Insurance Company. AOSSM checks author disclosures
against the Open Payments Database (OPD). AOSSM has not conducted
an independent investigation on the OPD and disclaims any liability or
responsibility relating thereto.
Ethical approval for this study was obtained from the regional ethics
commission of the Canton of Zu
¨rich (ID: 2017-00085).
The Orthopaedic Journal of Sports Medicine, 8(10), 2325967120964720
DOI: 10.1177/2325967120964720
ªThe Author(s) 2020
1
This open-access article is published and distributed under the Creative Commons Attribution - NonCommercial - No Derivatives License (https://creativecommons.org/
licenses/by-nc-nd/4.0/), which permits the noncommercial use, distribution, and reproduction of the article in any medium, provided the original author and source are
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Previous surveillance systems mainly focused on traumatic
injuries only and might not have captured the real number
of overuse injuries because of the lack of surveillance meth-
ods.
11
In fact, the evaluation of overuse injuries in ice
hockey is scarce, although proportions of 8%to 15%of all
injuries have been reported.
11,23
A new method for the reg-
istration of overuse sport injuries has recently been devel-
oped,
6
although it has not yet been applied in ice hockey.
The validated self-reported questionnaire contains 4
multiple-choice questions to document overuse problems
of different anatomic regions, which are often underre-
ported because most of these problems might not lead to
time loss.
6
For ice hockey, there is still a lack of injury
prevention research, as only 1 study has shown the effec-
tiveness of a preseason exercise program to prevent adduc-
tor muscle strains in professional ice hockey players.
28
The aim of this study was to assess the frequency, type,
location, and incidence of traumatic injuries using a stan-
dardized report form,
11
as well as the prevalence and the
relative effect of overuse injuries in professional male ice
hockey players using the Oslo Sports Trauma Research
Centre (OSTRC) Overuse Injury Questionnaire,
6
over a
1-year period (including the preparatory phase and game
season).
METHODS
Participants
Approval for this study was granted by the local ethics com-
mittee. Study inclusion criteria were the ability to under-
stand written/oral German or English and provide informed
consent to use the collected survey data for research pur-
poses. After the initial invitation was sent to 9 Swiss
National League teams, including their medical staff (ie,
physicians, sports physical therapists, massage therapists,
and athletic trainers), 6 teams decided to participate in the
study; the remaining 3 teams declined their participation
because of either a language barrier (ie, Italian- or French-
speaking medical staff) or an excessive amount of additional
workload. Another team left the study during the prepara-
tory phase after experiencing the workload associated with
the study. Overall, 5 teams comprising 122 ice hockey
players successfully completed the study.
Data Collection
Data were collected for approximately 1 year, which
included a preparatory phase during summer 2017 (from
week 0 to week 19) and the 2017-2018 season (ie, regular
season and playoffs/playouts from week 20 to week 50). One
person from each team’s medical staff was responsible for
active data collection. Two were sports physical therapists,
and 3 were massage therapists. All persons responsible for
data collection were in charge of the initial care after an
injury. They were present at all games and trainings. They
were asked to complete a standardized report form for each
traumatic injury occurring during dryland, weight lifting,
or on-ice training sessions or games. Each person
responsible for data collection was trained by the primary
investigator (R.B.) on how to complete the injury report
form correctly before study initiation because injuries in
Swiss ice hockey are not documented on a regular basis.
The final diagnosis of each reported traumatic injury was
made by the team physician. The person responsible for
data collection was also asked to gather information on the
number of dryland and on-ice training sessions per week.
To ensure compliance, this person was asked to send the
data collected to the corresponding author (R.B.) on a
weekly basis. In the case of incorrect completion of the
injury report form or missing data, this person was imme-
diately contacted by the primary investigator for
clarification.
For each player, we extracted the total time on ice during
the season from the individual statistics page of the Swiss
Ice Hockey Federation website (www.sihf.ch/de/game-
center/national-league/#/mashup/players/playerTimeOn
Ice/timeOnIce/desc/page/0/2017/2158). All players were
asked to complete the OSTRC Overuse Injury Question-
naire biweekly (every second week) during the 1-year study
period to collect information regarding overuse injuries.
Assessment of Traumatic Injuries
We used a standardized ice hockey injury data capture
form, which was previously developed and evaluated by
Flik et al,
11
to assess traumatic injuries. As noted, the form
was completed by the person responsible for data collection
for each team. The form comprised 32 questions, the major-
ity of which were multiple choice and focused on determin-
ing the following information: individual player’s
characteristics at the time of injury; whether the injury
occurred during a game (home vs away) or a training ses-
sion and, if so, during on-ice, dryland, or weight lifting ses-
sions; the game period and exact time when the injury
occurred; and the player position and playing zone where
the injury occurred. The cause of injury was documented,
and it was also ascertained if the player was able to con-
tinue playing or had to stop. Last, if applicable, the injury
was classified according to its grade, the diagnostic proce-
dures, and the treatment(s) undertaken. A time-loss defi-
nition of injury, which implied that the player missed 1 or
more training sessions or game events because of the
injury, was used.
26
Assessment of Overuse Injuries
The validated, self-reported OSTRC Overuse Injury Ques-
tionnaire was used to assess overuse injuries of different
body parts.
6
The questionnaire was handed out to all ice
hockey players before and after the first training session
of every second week and thereafter collected by the person
responsible for data collection for each team. For the non–
German speaking players (n ¼27), the English version of
the questionnaire was used. For the German-speaking
players (n ¼95), we translated the questionnaire according
to the guidelines for cross-cultural adaption of self-reported
measures
1
because only a version of the OSTRC Question-
naire to capture general health problems and illnesses—
2Brunner et al The Orthopaedic Journal of Sports Medicine

not targeting specific body parts—has been validated in
German.
13
The OSTRC Overuse Injury Questionnaire used
in the present study contains 4 multiple-choice questions
targeting shoulder, low back, hip/groin, and knee injuries,
with questions about (1) the difficulties participating in
normal training and competition during the past 2 weeks,
(2) the amount of training volume reduction, (3) the extent
of performance impairment, and (4) the degree of pain
related to ice hockey. The responses to each of the 4 ques-
tions were allocated a numerical value between 0 (no pro-
blems/limitations) and 25 (maximum problems/limitations)
and were subsequently summed to calculate a severity
score between 0 and 100 for each body part.
6,18
Data Analysis
Descriptive statistics are presented as frequencies and pro-
portions of any recorded traumatic injury. The overall inci-
dence of traumatic injuries was calculated as the number of
injuries per 1000 game or training hours during the season.
The prevalence of overuse injuries was calculated as the
number of players who reported any overuse problem, iden-
tified by a score >0 on any of the 4 questions or substantial
overuse problems, divided by the total number of respon-
dents.
6
Substantial overuse problems included only those
leading to moderate or severe reductions in training volume
or performance or an inability to participate in normal
training/competition.
18
The prevalence of overuse injuries
was calculated biweekly and for each body part; that is,
shoulder, low back, hip/groin, and knee. The cumulative
severity score was then calculated for each body part as the
sum of the severity scores of the respective body part for all
players over the study period divided by the number of
respondents on that 2-week interval.
6
The cumulative
severity score was the basis for comparison of the relative
effect of overuse problems in each body part.
5,18
For 6 of the
26 biweekly periods (ie, weeks 0, 2, 4, 12, 48, and 50), we
received questionnaire data from 3 teams because of hol-
idays or different start periods of the preparatory phase,
and therefore the data sets for these time points were not
included in the analyses.
RESULTS
Participants
The 122 players who participated in this study were from
10 different nations and had a mean age of 26 years.
Seventy-seven players had >3 years of experience in the
National League.
Traumatic Time-Loss Injuries
The incidence of time-loss injuries per 1000 player-game
hours during the season was 88.6, and it was 0.4 per 1000
player-training hours (Figure 1). Team injury incidence
ranged between 80 and 96 per 1000 player-game hours and
between 0.2 and 0.5 per 1000 player-training hours.
Overall, 23%of injuries were localized to the hip/groin/
thigh region; 17%, to the head; and 15%, to the lower leg/
foot (Figure 2). Twenty-four percent of injuries were diag-
nosed as muscle strains; 18%, as concussions; and 17%,as
contusions (Figure 3).
Non–time loss
injuries during
preparatory phase
and season
n = 142
Time-loss injuries
during
preparatory
phase
n = 42
Time-loss injury
incidence per 1000
player-game hours
n = 88.6
Time-loss injury
incidence per 1000
player-training hours
n = 0.4
Time-loss
injuries during
season
n = 137
Total number of
traumatic injuries
during preparatory
phase and season
n = 321
Figure 1. Overview of the number of traumatic ice hockey injuries.
The Orthopaedic Journal of Sports Medicine Epidemiology of Ice Hockey Injuries 3

Frequency, Type, and Location of Traumatic
Time-Loss and Non–Time-Loss Injuries
Seventy-five percent of all injuries occurred during games.
Of the remaining 25%of training-related injuries, 63%
occurred on-ice, 30%occurred during dryland, and 7%
occurred during weight lifting sessions. On average, a
player missed 32 training sessions and 7 games after an
injury. Eighteen percent of all injuries were localized to the
hip/groin/thigh region; 13%, to the face; and 11%,tothe
head. Twenty-eight percent of all injuries (ie, time-loss and
non–time loss) were diagnosed as contusions, and 21%were
diagnosed as muscle strains. The 3 main causes of all trau-
matic injuries were collisions with the opponent’s body
(31%), hits by a puck (16%), and collisions with the board
(13%). A game-related injury was reported in 23%of the
right forwards, 21%of the right defenders, and 20%of the
left forwards, followed by 17%of the center players, 15%of
the left defenders, and 4%of the goalkeepers. Twenty-seven
percent of injuries occurred in the defending zone along the
boards, followed by the attacking zone along the boards
(20%) and the neutral zone (16%) (Figure 4). Forty-four
percent of all injuries were reported during the central part
(minutes 7-13) of the second game period compared with
26%in the first period and 30%in the third period.
Prevalence of Overuse Injuries
The average response rate of the OSTRC Questionnaire
was 83%. The average number of players per team who
completed the questionnaire was 21. The yearly prevalence
rates of all overuse and substantial overuse injuries were
49%and 13%, respectively. The average prevalence rate for
all overuse hip/groin injuries was 16%(Figure 5D). The
shoulder, hip/groin, and knee regions alike accounted, on
average, for 4%of substantial overuse injuries (Figure 5, B,
D, and E). The average prevalence rates of all overuse and
substantial overuse injuries during the preparatory phase
were 58%and 15%and during the season were 43%and
14%, respectively (Figure 5A).
Hip/groin injuries and shoulder injuries showed the
highest and lowest cumulative severity scores, respectively
(Figure 6).
DISCUSSION
We investigated the frequency, type, location, and inci-
dence of traumatic injuries as well as the prevalence and
relative effect of overuse injuries affecting different body
regions in professional male ice hockey players from Swit-
zerland over a competitive season.
Traumatic Time-Loss Ice Hockey Injury Incidence
The incidence of traumatic time-loss injuries per 1000
player hours during the season was >1.5 times higher in
our study compared with National Hockey League (NHL)
statistics,
20
even though the European style of play was
considered to be less aggressive and physical compared
with the American style.
11
Because we collected data over
only 1 season, our results cannot be easily compared with
those of the prospective study of McKay et al,
20
which
Figure 2. Time-loss injuries per body region (n ¼179).
24
18 17
15
98
221
0
5
10
15
20
25
Injuries, %
Injury classifications
Figure 3. Time-loss injury classifications (n ¼179).
4Brunner et al The Orthopaedic Journal of Sports Medicine

spanned over 6 NHL seasons; they reported a range of trau-
matic injuries per 1000 player-games of 39 to 67 versus the
80 to 96 in our current study. On the other hand, the inci-
dence of 66 to 83 injuries per 1000 player-game hours
reported by a number of earlier studies focused on Euro-
pean ice hockey leagues
19,21-23
was more in line with our
range. However, injury definitions vary across the studies,
which makes a comparison difficult.
Frequency, Type, and Location of Traumatic
Time-Loss and Non–Time Loss Injuries
In agreement with other studies,
11,20,27
the incidence of all
traumatic injuries of our cohort was higher during games
than during training sessions, and the most common injury
mechanism was body checking. Most injuries occurred
along the boards even though body checking was the more
common injury mechanism compared with collision with
the boards. This may be explained by the fact that the
“event” of players getting checked by an opponent, followed
by collision with the board, was not specifically captured by
the injury report form. Thus, it was considered as a limita-
tion of the injury report form. We found that injuries were
more frequent in the second period, which corresponds to
previous observations from 7 World Championship tourna-
ments,
27
followed by the third period. This might be attrib-
uted to the fact that the level of fatigue may progressively
increase during a game, thus leading to more injuries.
Interestingly, a greater number of injuries occurred in the
first period of NHL games
20
; McKay and collaborators
20
speculated that, because players were not fatigued, they
had the capacity for greater physical play, which could lead
to a higher risk of injuries. Our results also showed that the
goalkeepers were at a lower risk of sustaining injuries than
were the field players, whereas the risk was highest for the
forwards, closely followed by defenders.
19,21,27
There is a
notable difference in the physical style of play associated
with each of these positions, which can explain the different
risk of injuries among goalkeepers, defenders, and
forwards.
20
Hip/Groin and Head Injuries as Major Problems
in Ice Hockey
Similarly to the NHL study of McKay et al,
20
we found that
the most commonly injured lower and upper body regions
were the hip/groin/thigh and the head, respectively. Ice
hockey players are particularly susceptible to adductor
muscle strains,
29
and this was confirmed by our data, as
muscle strains in the hip/groin/thigh region were the most
common traumatic time-loss injuries. Besides muscle
strains, the most common injuries leading to time loss were
concussions.
9,17
Ice hockey is a high-impact stop-and-go
sport, where body checking is permitted and players are
exposed to environmental risk factors such as, ice, boards,
sticks, and pucks, thus leading to a high risk of injuries,
especially to the head.
17
In 1997, the NHL and NHL
Players Association (NHLPA) launched the NHL-NHLPA
Concussion Program in order to improve the scientific
knowledge about concussion in professional ice hockey
players.
2
Hutchison et al
15,16
reported how a systematic
video analysis of NHL concussions contributed to
Figure 4. Number of time-loss and non–time loss injuries per playing zone (n ¼256). *Twenty-seven percent of injuries occurred in
the defending zone along the boards on the right or left side. **Twenty percent of injuries occurred in the attacking zone along the
boards on the right or left side.
The Orthopaedic Journal of Sports Medicine Epidemiology of Ice Hockey Injuries 5

identifying the injury mechanisms and various factors
associated with concussions, therefore helping the develop-
ment of education, evaluation, management, and preven-
tion strategies. Muscle strains and concussions might be
reduced via specific preventive strategies such as, injury
prevention training programs, modifications of game rules,
and/or implementation of arenas with flexible boards and
glass,
27,29
which should definitely require more attention in
ice hockey.
Overuse Injuries in Ice Hockey
Ice hockey seems to be associated with a high risk of over-
use injuries (49%) compared with those in other sports,
such as football (13%) and cross-country skiing, floorball,
handball, road cycling, and volleyball (39%).
5,18
To our
knowledge, this is the first epidemiological study investi-
gating overuse injuries in professional ice hockey players.
Based on our results, the hip/groin region, which was
0
10
20
30
40
50
60
70
80
90
0 4 8 12162024283236404448
Prevalence (%)
Week number
Overall
Preparatory Phase Season
Holidays
A
0
5
10
15
20
25
30
35
Prevalence (%)
Shoulder
Holidays
Preparatory
Phase Season
BLower back
Holidays
Preparatory
Phase Season
C
0
5
10
15
20
25
30
35
0 4 8 12162024283236404448
Prevalence (%)
Week number
Hip/groin
Season
Preparatory
Phase
Holidays
D
0 4 8 12162024283236404448
Week number
Knee
Holidays
Season
Preparatory
Phase
E
Figure 5. Prevalence of all overuse problems (light gray area) and substantial overuse problems (dark gray area) (A) overall and
located at the (B) shoulder, (C) low back, (D) hip/groin, and (E) knee.
6Brunner et al The Orthopaedic Journal of Sports Medicine

previously reported as the most problematic region for ice
hockey players,
4,10,25,29,31
showed the highest relative effect
of overuse injuries. Clinical entities, such as adductor-
related pain,
14
hip-related groin pain,
30
and femoroacetab-
ular impingement syndrome (FAIS),
12
are often used to
classify hip/groin pain in ice hockey players. Ice hockey
skating patterns (ie, external rotation in hip abduction dur-
ing the push-off phase and internal rotation in hip flexion
during the recovery phase) were previously described to be
at-risk positions for FAIS in Peewee ice hockey players and
should be taken into consideration in the prevention of
overuse injuries of the hip.
25
Furthermore, the imbalance
between hip and abdominal muscle strength (ie, strong
adductor muscles versus weak lower abdominal muscles)
might be an underlying cause of athletic pubalgia.
8
How-
ever, a classification, such as a specific diagnosis of hip/
groin overuse injuries, using the OSTRC Overuse Injury
Questionnaire is not possible because it only captures
self-reported overuse problems of different anatomical
regions. A recent investigation
31
showed a high prevalence
of hip/groin problems in ice hockey players regardless of the
playing position, thus indicating that all players might
potentially benefit from prevention strategies for overuse
injuries.
The highest prevalence of all overuse (85%) and substan-
tial overuse (25%) injuries during the preparatory phase—
at the beginning of this study—might be attributed to the
fact that players were just starting out the summer train-
ing and were not in as good condition as they were later in
the season and thus were more prone to injuries. Another
reason might be the high training load during the summer
months (on average, there were 14 h/wk of dryland training
during the preparatory phase vs 3 h/wk during the season)
leading to overuse injuries. After the preparatory phase
load, there is also the season match load, with often a con-
gested calendar (2-3 games per week), including short
recovery times; this, in turn, can lead to a generally high
injury rate, as previously seen in professional soccer
players.
7
Limitations
One of the limitations of this study is the sampling of
approximately 50%of invited teams, which might have led
to a potential detection and sampling bias. This limitation
can only be addressed by increasing the total number of
teams; however, this was not possible because our current
study was restricted to ice hockey teams with the ability to
understand German or English. One of the major limita-
tions involves the reporting bias of traumatic injuries by
the person who was responsible for data collection for each
team. However, this was anticipated by the primary inves-
tigator training each person using the injury report form
before data collection. A comparison among the teams high-
lighted that some medical staff members were more likely
to report minor non–time loss injuries, such as contusions
by pucks. For example, in some teams, contusions were
consistently treated using an ice pack by the person respon-
sible for data collection, whereas other teams did not treat
them and therefore did not report them. The number and
type of time-loss injuries among teams were, however, com-
parable. Another limitation is associated with the OSTRC
Overuse Injury Questionnaire, which only focuses on pre-
defined injury regions and does not allow other overuse
injuries (eg, FAIS) to be classified. Ideally, each problem
reported by an athlete is quickly followed up with a confir-
matory medical examination; however, this obviously may
increase the logistical difficulty and cost of conducting a
study.
6
Perspectives
The high prevalence and relative effect of overuse injuries,
with hip/groin problems at the top, highlight a significant
medical concern in ice hockey athletes that should be
addressed in the future. Future research should focus on
the development of injury prevention programs, especially
for the hip/groin area and head, to decrease the prevalence
of injuries. It is of high importance to further develop imple-
mentation strategies in order to address injury prevention
program adherence in different ice hockey teams.
CONCLUSION
Muscle strains and concussions were the most frequent
time-loss injuries in Swiss professional ice hockey players.
The high prevalence and relative effect of overuse injuries,
particularly affecting the hip/groin, highlight a significant
medical concern in ice hockey athletes that should be care-
fully addressed in the future.
ACKNOWLEDGMENT
The authors thank all the teams and team physicians who
participated in the study. Special thanks go to Tommaso
Franceschini, Thomas Ritter, Luca Grotto, Andreas
Badertscher, Mattia Stendahl, Gerrit Beekmann, Mathias
Wanner, Niklaus Hess, and Roger Geering for their great
efforts in data collection. The authors also thank Jean-
Claude Ku
¨ttel, who initiated the connection with the
teams.
11.5
11.8
20.6
23.6
0 5 10 15 20 25
shoulder
lower back
knee
hip/groin
Cumulative Severity Sco re
Figure 6. Relative effect of overuse injuries affecting the
shoulder, low back, hip/groin, and knee, indicated as the
cumulative severity score.
The Orthopaedic Journal of Sports Medicine Epidemiology of Ice Hockey Injuries 7

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