Ice Hockey Injuries Part 2: How and Why Injury Occurs

In part one of this series, we discussed who gets hurt and when they get hurt in professional and collegiate hockey. If we understand how these athletes get injured and how their loss impacts the player and team, we can begin to develop an adequate injury reduction program.

How Do They Get Hurt?

The vast majority of hockey injuries are contact-related.1 During games, about 50% of injuries result from contact with another player, while contact with another object (boards, puck, etc.) account for 39.6% of injuries.1 In the NHL, the causes of contact injuries breakdown as follows:

  • Body checking (28.6%)
  • Incidental contact (14.3%)
  • Hit by puck (13.5%)
  • Contact with environment (9.4%)
  • Intentional player contact (7.4%)

Though common in practice (32% of practice injuries), non-contact injuries make up only 9.7% of in-game injuries and 14.8% of all injuries.1 Only 11.7% of man-games lost were due to such injuries in 2009-2012 games (out of 1,921 games).

These numbers provide insight into the general cause of injury, but to work on prevention we must know what types of injury most commonly occur among ice hockey players?

What Are The Most Common Injuries?

Injuries most often sustained during gameplay versus during practice over a 16-season timeframe are shown in the table below.1

Injury Incidence (Game vs. Practice)
Injury Game Practice
Internal derangement of the knee 13.5% 10.1%
Concussion 9.0% 5.3%
Acromioclavicular joint injury 8.9% 4.4%
Upper leg contusion 6.2% N/A
Musculotendinous strain of the hip/groin region 4.5% 13.1%
Ankle ligament sprain N/A 5.5%

During games, the knee internal derangement appears most prevalent among injuries and player contact is the most common culprit. Of the most common severe injuries reported, musculotendinous injuries of the pelvis/hip was the only pathology (6.2%) caused via a primarily non-contact mechanism.

Similarly, the most common sites of injury among NHL players include:

  • Head (17%)
  • Thigh (14%)
  • Knee (13%)
  • Shoulder (12%)

With regards to man-games lost, these regions also had the largest impact on their respective teams. Unfortunately, this study did not break the body regions into specific injuries/pathologies.

Given the fairly vague description of the injuries in these above studies, we need to look at the specific injuries reported in the literature.

ACL Tear

Between 2006 and 2010, only 47 players sustained an anterior cruciate ligament tear in the NHL.8 This is significantly lower than most professional contact team sports. Three goaltenders, eight defensemen, and 36 forwards sustained the injury.

The reported mechanism for all but one of these injuries was contact with another player and/or with the boards. In addition to the primary ACL rupture, 68% of injuries reported a concomitant meniscal or medical collateral ligament injury as well.

MCL Tear

Between the 2003-04 to 2010-11 seasons, one collegiate ice hockey program reported 13 MCL injuries. Ten different players were injured (12.7%), resulting in an incident rate of 0.44 per 1,000 athlete exposures. 77% of these injuries involved contact, while 15% of cases reported an acute non-contact injury.6

Hip Pathology

Over a four-year span, the NHL reported 890 hip and groin injuries.5 Of those reported, 10.6% were intra-articular. Of them, 10.6% were intra-articular. Although injuries during games and practice occurred at a similar rate (44.6 vs. 41.4%, respectively), the majority occurred during the regular season (71.2%). The most frequent intra-articular hip diagnoses are shown in the pie chart below:

Pie Chart Horizontal

Looking at player position, goaltenders experience significantly higher injury rate per 1000 player-game appearances compared with all other players.

In a more recent study, it was determined that following hip arthroscopy for treatment of femoroacetabular impingement, only 67% of NHL players continued playing 5 years after post-operatively. Players who did not continue playing past the five-year mark had significantly longer duration of symptoms before surgery.10

How Does Injury Affect Team’s Performance?

Regardless of coaching or talent, a team’s success can hinge on injuries. According to injuries negatively impact an NHL team’s success. Over the past five seasons, the Stanley Cup champion has been among the top five least injured teams during the regular season. Along the same lines, Washington Capitals ­– who won this season’s President’s Trophy (best regular season record) – also had the least man-games lost due to injury.

Top 5 Fewest Man-Games Lost (2009-10 to 2015-16)
Rank Team Post-Season Appearances Stanley Cup Championships
1 Los Angeles 6 2
2 Boston 5 1
3 Chicago 7 3
4 New York Rangers 6 0
5 Dallas 2 0

As to the five most injured teams, none of them (with the exception of the Pittsburgh Penguins) have had consistent success over the past five years. In fact, two of them – Columbus Blue Jackets and Edmonton Oilers – also had the worst overall records over this timeframe.

Top 5 Most Man-Games Lost (2009-10 to 2015-16)
Rank Team Post-Season Appearances Stanley Cup Championships
1 Colorado 2 0
2 Pittsburgh 7 1
3 Columbus 1 0
4 New York Islanders 2 0
5 Edmonton 0 0

How Does Injury Affect an Athlete’s Performance?

Significant injuries affect not only team performance but also a returning player’s productivity and durability tends to decline:

  • Meniscal injury shortens the career for all positions.
  • For wings and centers, games played decreased from 71.2 to 58.2 in the first full season after ACL injury and to 59.29 in the second full season.8
  • Offensive production suffered, with a 31% fewer goals scored per season, 60% fewer assists, and 42% fewer total points compared with an uninjured control group.8

Only 37.5% of previously selected All-Stars regained this honor following return to play.8

What’s the Financial Impact?

Between the 2009-10 and 2011-12 seasons, 50.9% of NHL players missed at least one game, adding up to a total salary cost of $218 million per year.4

Thus, injury heavily impacts team performance and has serious financial implications. Being able to identify athletes at risk and develop programs to lessen the likelihood of injury are paramount to a successful organization.

  1. Agel J, Dompier T, Dick R, Marshall S. Descriptive Epidemiology of Collegiate Men’s Ice Hockey Injuries: National Collegiate Athletic Association Injury Surveillance System, 1988–1989 Through 2003–2004. Journal of Athletic Training. 2007;42(2):241-248.
  2. Flik K. American Collegiate Men's Ice Hockey: An Analysis of Injuries. American Journal of Sports Medicine. 2005;33(2):183-187. doi:10.1177/0363546504267349.
  3. Currier, Nathan. "The Most Injured NHL Teams Since the 2009-2010 Season." N.p., 12 Apr. 2016. Web. 22 Apr. 2016.
  4. Donaldson L, Li B, Cusimano MD. Economic burden of time lost due to injury in NHL hockey players. Inj Prev. 2014;20(5):347-349. doi:10.1136/injuryprev-2013-041016.
  5. Epstein DM, McHugh M, Yorio M, Neri B. Intra-articular Hip Injuries in National Hockey League Players: A Descriptive Epidemiological Study. American Journal of Sports Medicine. 2013;41(2):343-348. doi:10.1177/0363546512467612.
  6. Grant JA, Bedi A, Kurz J, Bancroft R, Miller BS. Incidence and Injury Characteristics of Medial Collateral Ligament Injuries in Male Collegiate Ice Hockey Players. Sports Health. 2013;5(3):270-272. doi:10.1177/1941738112473053.
  7. McKay CD, Tufts RJ, Shaffer B, Meeuwisse WH. The epidemiology of professional ice hockey injuries: a prospective report of six NHL seasons. British Journal of Sports Medicine. 2014;48(1):57-62. doi:10.1136/bjsports-2013-092860.
  8. Sikka R, Kurtenbach C, Steubs JT, Boyd JL, Nelson BJ. Anterior Cruciate Ligament Injuries in Professional Hockey Players. American Journal of Sports Medicine. 2016;44(2):378-383. doi:10.1177/0363546515616802.
  9. Tuominen M, Stuart MJ, Aubry M, Kannus P, Parkkari J. Injuries in men's international ice hockey: a 7-year study of the International Ice Hockey Federation Adult World Championship Tournaments and Olympic Winter Games. British Journal of Sports Medicine. 2015;49(1):30-36. doi:10.1136/bjsports-2014-093688.
  10. Menge TJ, Briggs KK, Philippon MJ. Predictors of Length of Career After Hip Arthroscopy for Femoroacetabular Impingement in Professional Hockey Players. American Journal of Sports Medicine. 2016;44(9):2286-2291. doi:10.1177/0363546516650649.