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Spinal Cord Injuries in Canadian Amateur Hockey: A Study With NHL Implications?

Every so often, my education crosses over neatly with current events. Like when we talked about the Wingate test during training camp, or when we talked about knee injuries the same week Mike Cammalleri fell awkwardly and ripped up his knee. With a pair of questionable hits into the boards coming in the last two weeks and getting everyone talking (when they're not railing against Matt Cooke), it just so happens that for my sport injury class, I'm reading a paper on the incidence of spinal cord injuries in Canadian amateur hockey. After finishing the paper, I felt it would be worth taking a quick look at some of the findings, and conclude by questioning just why some in the media and on the Internet continue not only to defend certain types of cheap shot, but indeed even glorify them.

Note: If you have access to PubMed or another, similar article indexing service (check with your University librarian), you can download and read the paper yourself. The citation:

Tator CH, Provvidenza C, and Cassidy JD. Spinal injuries in Canadian ice hockey: an update to 2005. Clin. J. Sport Med., 19(6): 451-456. PM: 19898071

Background

Judging from the References section of this paper, Dr. Tator specializes in the study of catastrophic injury in sport, and has been looking at spinal cord injuries in hockey since 1981. In the early '80s, he found a sharp increase in the number of spinal cord injuries in hockey could be attributed primarily to checking from behind, leading to the first penalty for the act from the CAHA (Hockey Canada) in 1985. He's checked back on the situation several times since, and has finally got good news for us: after nearly twenty years of double-digit numbers of annual spinal cord injuries, we're finally starting to see a consistently reduced number of these injuries in Canadian amateur hockey.

The authors indicate a few reasons for the increase happening in the first place. One theory is that the increased prevalence of helmets and face masks created a feeling of invulnerability and reduced accountability in the players, terming it "risk compensation." They're quick to point out that helmets are likely not a direct cause of injury, but that there may be a cultural effect due to them. Another theory is that as players have gotten bigger, stronger, and faster, and been encouraged to play more aggressively, more reckless plays have been the natural result.

The authors have also noted a number of reasons why it may be decreasing. Grassroots education programs like "Smart Hockey with Mike Bossy" and the STOP program, increased and more consistent rule enforcement, as well as a change in the overall coaching culture of the sport at lower levels, have all been considered as possibilities. However, it's difficult to tease out the effects of each of these, since there's a large degree of overlap in the time periods over which each of these changes has occurred.

By the Numbers

The first figure that may astonish people is that more than 2/3 (67.7%) of all non-professional hockey spinal cord injuries in Canada come in players between 11 and 20 years of age. In particular, nearly half of all injuries (47.6%) occur between the ages of 16 and 20. I would suspect that a large number of these come from major junior and, to a lesser degree, Junior A, as players try to impress NHL scouts, or just retain their positions on teams coached or managed by former players. The authors also indicate that part of this high incidence may be due to players gaining the strength and speed to deliver these hits before they've developed the corresponding spinal musculature (and, I would add, bone mineral density) to absorb them.

What's really interesting, however, are the common mechanisms of injury. The top three mechanisms by a longshot are three types of hit that should be familiar if you've been watching the NHL this year. They are presented below, hopefully without the perception of an agenda, to illustrate what, precisely, we're talking about.

Mechanism #1: Check/push from behind (35.0%)
Recent NHL Example: Maxim Lapierre cross-checks Scott Nichol from behind at the goal line; Nichol falls into the boards, injuring his shoulder.
Resultant Penalty: None on the play, with a four-game suspension issued thereafter.

Mechanism #2: Check/push not from behind (25.4%)
Recent NHL Example: Alex Ovechkin shoves Brian Campbell sideways into the boards. The hit broke Campbell's clavicle and ribs, ending his regular season and jeopardizing his playoffs.
Resultant Penalty: Five minutes for boarding and a game misconduct, with two more games added after the fact.

Mechanism #3: Tripped on ice (20.4%)
Recent NHL Example: Jarome Iginla gets his stick under Sheldon Souray's skate, sending him into the end boards, resulting in a concussion.
Resultant Penalty: Two minutes for tripping.

With respect to the recent decreases in injury, the interesting trend I noted was in Figure 1, for those following along at home. While there was a sharp drop in injuries in "juvenile" (i.e. registered adult hockey) after 2000, it was preceded by a slightly less sharp drop-off at the developmental level beginning around 1996. (Since a quick look on Google doesn't tell me anything, when did the CHL introduce its rule against checking from behind?) It's also worth noting that not only are injuries down in the first half of this decade compared to the previous two, but the number of injuries due to hits from behind are also down (36.6% from before 2000 to 25% since), which is an encouraging sign.

So What About the NHL?

It seems obvious to me that the NHL should be doing everything it can to discourage these kinds of hits, and indeed, it does to an extent. The third one, tripping, is probably the toughest one to deal with, because there is no major for it, nor is there usually any cause for there to be. The NHL did step in and force there to be a penalty for interference or tripping when two players jockey for position on an icing call, to reduce incidents ending in injury like this one between Torrey Mitchell and Kurtis Foster. However, punishment for the other types of hit have been wildly inconsistent: star players get different penalties from scrubs; the extent of injury weighs more greatly on the outcome of supplementary discipline than the danger level of the play, rather than the other way around; punishment levels seem to change depending on how much media attention's been garnered, and whether it's something the NHL has publicly stated it's "trying to stamp out," though even that is rather questionable, in light of the Matt Cooke-Marc Savard incident.

The bottom line is, the NHL needs to be a lot tougher on crime, and much more consistently tough, than it has been to this point. We've been fortunate, really, that there hasn't been a serious neck injury resulting from one of these dangerous plays, because if someone went in at the wrong angle, that could be it for their career, and then what would the NHL do? Throwing the book at one guy while letting everyone else off with a couple of games here or there -- all while handing out six games for a stupid sex joke -- is a poor substitute for changing the culture of the game away from supporting reckless endangerment. When the NHL decided it wanted bench-clearing brawls to end, once and for all, they implemented a ten-game ban for the first guy off the bench. They have the power to do something similar here, but I doubt there's much will for it at this point.

Perhaps most saddening, though, is the fact that even when it's clear and obvious when a dangerous play has occurred, fans and media alike come out of the woodwork to defend a player. Mike Milbury and Pierre McGuire stated on NBC during the first intermission of the Capitals-Blackhawks game this weekend that they didn't think Ovechkin should've been tossed. Robert L of Habs Eyes on the Prize here on SB Nation defended Maxim Lapierre's hit as a "hockey play," and his suspension part of "the pussification of hockey." Hell, I'm even guilty of it myself, defending Tomas Plekanec's slew-foot on Denis Grebeshkov last year as some sort of accident, even after he was suspended for two games over it; with the benefit of hindsight, I'm finally prepared to admit that I was wrong on that one.

I think we, as hockey fans, need to start realizing that, while the violence inherent to the game is part of its appeal, it should not come at the expense of causing a career-ending injury, which this study demonstrates is very much possible. Injuries happen and accidents happen, and that's all just a part of the game, but surely we can do a better job than we have to this point of recognizing when a player crosses the line between making a good hockey play and making a reckless, dangerous play that doesn't need to be a part of the game. The NHL owes it not only to themselves and their players -- the League's "greatest asset," as Gary Bettman puts it -- but to us, the fans, to ensure that the players we pay dearly to watch aren't jeopardized unnecessarily. We also owe it to ourselves to expect better, both from the League and from ourselves. If we continue to support reckless play and consider it, "part of the game," we're as much a part of the problem as the guys like Cooke and Lapierre and Ovechkin.

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