The association between moderate and vigorous physical activity and time to medical clearance to return to play following sport-related concussion in youth ice-hockey players

Object The authors investigated return-to-play duration for initial and recurrent concussion in the same season in 2 teams of junior (16–21-year-old) ice hockey players during a regular season. Methods The authors conducted a prospective cohort study during 1 junior regular season (2009–2010) of 67 male fourth-tier ice hockey players (mean age 18.2 ± 1.2 years [SD], range 16–21 years) from 2 teams. Prior to the start of the season, every player underwent baseline assessments that were determined using the Sideline Concussion Assessment Tool 2 (SCAT2) and the Immediate Post-Concussion Assessment and Cognitive Test (ImPACT). The study protocol also required players who entered the study during the season to complete a baseline SCAT2 and ImPACT. If the protocol was not followed, the postinjury test results of a player without true baseline test results were compared with previously established age- and sex-matched group normative levels. Each game was directly observed by a physician and at least 1 neutral nonphysician observer. Players suspected of suffering a concussion were evaluated by the physician during the game. If a concussion was diagnosed, the player underwent clinical evaluation at the physician's office within 24 hours. The return-to-play decision was based on clinical evaluation guided by the Zurich return-to-play protocol (contained in the consensus statement of international expert opinion at the 3rd International Conference on Concussion in Sport held in Zurich, November 2008). This clinical evaluation and return-to-play protocol was augmented by the 2 tests (SCAT2 and ImPACT) also recommended by the Zurich consensus statement, for which baseline values had been obtained. Results Seventeen players sustained a physician-observed or self-reported, physician-diagnosed concussion during a physician-observed ice hockey game. The mean clinical return-to-play duration (in 15 cases) was 12.8 ± 7.02 days (median 10 days, range 7–29 days); the mean number of physician office visits by players who suffered a concussion (15 cases) was 2.1 ± 1.29 (median 1.5 visits). Five of the 17 players who sustained a concussion also suffered a recurrent or second concussion. One of the 5 individuals who suffered a repeat concussion sustained his initial concussion in a regular season game that was not observed by a physician, and as a result this single case was not included in the total of 21 concussions. This initial concussion of the player was identified during baseline testing 2 days after the injury and was subsequently medically diagnosed and treated. The mean interval between the first and second concussions in these 5 players was 78.6 ± 39.8 days (median 82 days), and the mean time between the return-to-play date of the first and second concussions was 61.8 ± 39.7 days (median 60 days). Conclusions The mean rates of return to play for single and recurrent concussions were higher than rates cited in recent studies involving sport concussions. The time interval between the first and second concussions was also greater than previously cited. This difference may be the result of the methodology of direct independent physician observation, diagnosis, and adherence to the Zurich return-to-play protocol.

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Dynamic Analysis of Custom-Fitted Functional Knee Braces: EMG and Brace Migration during Physical Activity

Journal of Sport Rehabilitation ◽

10.1123/jsr.8.2.109 ◽

1999 ◽

Vol 8 (2) ◽

pp. 109-122 ◽

Cited By ~ 1

Author(s):

John P. Miller ◽

James C. Vailas ◽

Ronald V. Croce ◽

Robert Confessore ◽

Kerriann Catlaw

Keyword(s):

Physical Activity ◽

Dynamic Analysis ◽

Motor Unit ◽

Ice Hockey ◽

Thigh Muscle ◽

Median Frequency ◽

Knee Brace ◽

Hockey Players ◽

Hard Shell ◽

Knee Braces

This study examined the effects of (a) functional knee braces on thigh muscle EMG and (b) physical activity and leg shape on knee brace migration. Ten female college ice hockey players were fitted with a strap-secured functional knee brace (SSB) and a hard-shell functional knee brace with strapping. Participants performed a side-step maneuver, a treadmill ran, and an obstacle course. Significant differences were noted in hamstring and quadriceps EMG median frequency (mfEMG) while wearing the SSB compared with the control condition. Significant downward shifts were noted in hamstring mfEMG for both braces when compared with the control condition. There was greater brace migration for the obstacle course for both brace types. No relation was found between leg shape and the amount of migration. This study suggests that custom-fitted functional knee braces alter the motor unit recruitment patterns of the thigh musculature during physical activity and that they do not migrate significantly during physical activity.

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Canadian Minor Hockey Participants’ Knowledge about Concussion

Canadian Journal of Neurological Sciences / Journal Canadien des Sciences Neurologiques ◽

10.1017/s0317167100007046 ◽

2009 ◽

Vol 36 (03) ◽

pp. 315-320 ◽

Cited By ~ 63

Author(s):

Michael D. Cusimano ◽

Mary L. Chipman ◽

Richard Volpe ◽

Peter Donnelly

Keyword(s):

Traumatic Brain Injury ◽

Brain Injury ◽

Physical Therapy ◽

Ice Hockey ◽

Return To Play ◽

Educational Strategies ◽

Greater Toronto Area ◽

Minor League ◽

Hockey Players ◽

The Usa

Abstract:Background and Objectives:In Canada and the USA, ice hockey is a cause of traumatic brain injury. Post-concussive symptoms are the most important feature of the diagnosis of concussion in sports and it is recommended that athletes not return to play while still symptomatic. Lack of knowledge of concussions could therefore be one of the main detriments to concussion prevention in hockey. The purpose of this research is to describe what minor league hockey players, coaches, parents and trainers know about concussion and its management.Methods:A questionnaire to assess concussion knowledge and return to play guidelines was developed and administered to players at different competitive levels (n = 267), coaches, trainers and parents (total adults n = 142) from the Greater Toronto Area.Results:Although a majority of adults and players could identify mechanisms responsible for concussion, about one-quarter of adults and about a quarter to a half of children could not recall any symptoms or recalled only one symptom of a concussion. A significant number of players and some adults did not know what a concussion was or how it occurred. Almost half of the players and a fifth of the adults incorrectly stated that concussion was treated with medication or physical therapy. Nearly one quarter of all players did not know if an athlete experiencing symptoms of concussion should continue playing.Conclusions:This study demonstrated that a significant number of people held misconceptions about concussion in hockey which could lead to serious health consequences and creates a need for better preventive and educational strategies.

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Acromioclavicular Joint Injuries in Professional Ice Hockey Players: Epidemiologic and MRI Findings and Association With Return to Play

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967120964474 ◽

2020 ◽

Vol 8 (11) ◽

pp. 232596712096447

Author(s):

Lawrence M. White ◽

Jonathan Ehmann ◽

Robert R. Bleakney ◽

Anthony M. Griffin ◽

John Theodoropoulos

Keyword(s):

Acromioclavicular Joint ◽

Ice Hockey ◽

Return To Play ◽

Low Grade ◽

Mri Findings ◽

Grade 5 ◽

Significant Difference ◽

Hockey Players ◽

Mri Scans ◽

Grade 3

Background: Acromioclavicular joint (ACJ) injuries are common in ice hockey players and are traditionally evaluated with conventional radiography, which has recognized limitations in the accurate characterization of the spectrum of soft tissue injuries and severity/grade of injury sustained. Purpose: To evaluate the epidemiologic, clinical, and magnetic resonance imaging (MRI) findings in professional ice hockey players who have sustained acute ACJ injuries. Study Design: Case series; Level of evidence, 4. Methods: A retrospective review was performed of professional National Hockey League (NHL) players referred for MRI evaluation of acute ACJ injuries. All MRI scans were assessed for status of the ACJ, ligamentous stabilizers, and surrounding musculature. MRI-based overall grade of ACJ injury (modified Rockwood grade 1-6) was assigned to each case. Data regarding mechanism of injury, player handedness, clinical features, and return to play were evaluated. Results: Overall, 24 MRI examinations of acute ACJ injuries (23 patients; mean age, 24 years) were reviewed. We found that 50% of injuries were sustained during the first period of play, and in 75% of cases, injuries involved the same side as player shooting handedness. Analysis of MRI scans revealed 29% (7/24) grade 1 ACJ injuries, 46% (11/24) grade 2 injuries, 21% (5/24) grade 3 injuries, and 4% (1/24) grade 5 injuries. Trapezius muscle strains were seen in 79% and deltoid muscle strain in 50% of cases. Nonoperative management was used for 23 injuries; 1 patient (grade 5 injury) underwent acute reconstructive surgery. All players successfully returned to professional NHL competition. Excluding cases with additional injuries or surgery (n = 3) or convalescence extending into the offseason (n = 3), we found that the mean return to play was 21.4 days (7.2 games missed). No statistically significant difference was observed in return to play between nonoperatively treated grade 3 injuries (mean, 28.3 days) and grade 1 or 2 injuries (mean, 20.1 days). However, grade 3 injuries were associated with a greater number of NHL scheduled games missed (mean, 12.7) compared with lower grade injuries (mean, 6.1) ( P = .027). Conclusion: The spectrum of pathology and grading of acute ACJ injuries sustained in professional ice hockey can be accurately assessed with MRI; the majority of injuries observed in this study were low grade (grades 1 and 2). Although grade 3 injuries were associated with a greater number of games missed, similar return-to-play results were observed between nonoperatively treated grade 3 and grade 1 or 2 ACJ injuries.

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A prospective study of physician-observed concussions during junior ice hockey: implications for incidence rates

Neurosurgical FOCUS ◽

10.3171/2010.9.focus10186 ◽

2010 ◽

Vol 29 (5) ◽

pp. E4 ◽

Cited By ~ 63

Author(s):

Paul Sean Echlin ◽

Charles H. Tator ◽

Michael D. Cusimano ◽

Robert C. Cantu ◽

Jack E. Taunton ◽

...

Keyword(s):

Assessment Tool ◽

Single Case ◽

Impact Testing ◽

Ice Hockey ◽

Return To Play ◽

Cognitive Test ◽

Test Results ◽

Hockey Players ◽

Follow Up Studies

Object The objective of this study was to measure the incidence of concussion (scaled relative to number of athlete exposures) and recurrent concussion within 2 teams of fourth-tier junior ice hockey players (16–21 years old) during 1 regular season. Methods A prospective cohort study called the Hockey Concussion Education Project was conducted during 1 junior ice hockey regular season (2009–2010) involving 67 male fourth-tier ice hockey players (mean age 18.2 ± 1.2 years, range 16–21 years) from 2 teams. Prior to the start of the season, every player underwent baseline assessments using the Sideline Concussion Assessment Tool 2 (SCAT2) and the Immediate Post-Concussion Assessment and Cognitive Test (ImPACT). The study protocol also required players who entered the study during the season to complete baseline SCAT2 and ImPACT testing. If the protocol was not followed, the postinjury test results of a player without true baseline test results would be compared against previously established age and gender group normative levels. Each regular season game was observed by a qualified physician and at least 1 other neutral nonphysician observer. Players who suffered a suspected concussion were evaluated at the game. If a concussion diagnosis was made, the player was subsequently examined in the physician's office for a full clinical evaluation and the SCAT2 and ImPACT were repeated. Based on these evaluations, players were counseled on the decision of when to return to play. Athlete exposure was defined as 1 game played by 1 athlete. Results Twenty-one concussions occurred during the 52 physician-observed games (incidence 21.5 concussions per 1000 athlete exposures). Five players experienced repeat concussions. No concussions were reported during practice sessions. A concussion was diagnosed by the physician in 19 (36.5%) of the 52 observed games. One of the 5 individuals who suffered a repeat concussion sustained his initial concussion in a regular season game that was not observed by a physician, and as a result this single case was not included in the total of 21 total concussions. This initial concussion of the player was identified during baseline testing 2 days after the injury and was subsequently medically diagnosed and treated. Conclusions The incidence of game-related concussions (per 100 athlete exposures) in these fourth-tier junior ice hockey players was 7 times higher than the highest rate previously reported in the literature. This difference may be the result of the use of standardized direct physician observation, diagnosis, and subsequent treatment. The results of this study demonstrate the need for follow-up studies involving larger and more diverse sample groups to reflect generalizability of the findings. These follow-up studies should involve other contact sports (for example football and rugby) and also include the full spectrum of gender, age, and skill levels.

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Performance After Concussion in National Hockey League Players

Journal of Athletic Training ◽

10.4085/1062-6050-126.20 ◽

2021 ◽

Vol 56 (4) ◽

pp. 404-407

Author(s):

Aidan L. Neustadtl ◽

William K. Bukowski ◽

Alan Neustadtl ◽

David Milzman

Keyword(s):

Outcome Measure ◽

Cross Sectional Study ◽

Ice Hockey ◽

Return To Play ◽

National Hockey League ◽

Sectional Study ◽

Cross Sectional ◽

Hockey Players ◽

Player Performance ◽

Interesting Area

Context Concussions in ice hockey players are an interesting area of study due to the fast-paced and high-impact nature of the sport. Recently, researchers have focused on player performance after return from concussion to evaluate subclinical deficits that were previously missed. Objective To examine National Hockey League (NHL) player performance from 2013 to 2019 and compare performance before a concussion with performance immediately after recovering to assess the current NHL return-to-play protocol. Design Cross-sectional study. Setting The NHL Injury Viz and sports reporting websites. Patients or Other Participants Players in the NHL who sustained concussions from 2013 to 2019. Main Outcome Measure(s) Goals, assists, points, plus-minus, time on ice (TOI), and hits. Results When goals, assists, points, plus-minus, TOI, and hits were examined, only TOI was different after the players returned from injury, and this TOI difference was not substantively important. Conclusions After concussion, NHL player performance did not change.

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