Catastrophic Neck Injuries
Russell Gunner, C.A.T. (C)

The season is in full swing and unfortunately the injuries have started also. Over the past several years I have touched on several injuries you see in hockey, but have avoided the most serious of them, the neck or spinal cord injuries. Nobody likes to talk about them, but they are apart of the sport and should be dealt with appropriately. The injury can leave an athlete as a possible paraplegic or even fatal if it is not handled properly.

A recent study showed that body checking in youth hockey (9-15 years old) accounted for 86% of game-time injuries, while 23% of these were to the head or neck. That means this is one area that can't be ignored.
In American football, several studies have been done in relation to the effect of new equipment, rules and coaching and how it can relate to injury prevention. In 1968, there were approximately 3.4 deaths in football for every 100,000 players. In 1976, significant rule changes were implemented (prohibition of head impact in blocking, tackling and head butting) as well as new helmet standards. In 1978, the incidence of deaths decreased to approximately 0.5 per 100,000 players, as well as, a significant decrease in spinal cord injuries.

Football is not the only sport that can cause such catastrophic injuries. Charles Tator and SportSmart Canada in the early 1980s drew attention to cervical spine injuries in hockey. They reviewed hospital records from 1948 to 1973 with no reported ice hockey spinal cord injuries. Between 1974 and 1981, six cases were seen at these hospitals. This increase led to the formation of a committee on the prevention of spinal cord injuries in ice hockey. They found that there were an average of 17 cases per year between 1981 and 1996. In 1994, the incidence of severe spinal injuries with paralysis was three times greater in hockey than in football.

The majority of the injuries were committed during illegal play, such as hitting from behind (60% in 1966-1987). As result of this data that they found, in 1985 they introduced the rule of no hitting or checking from behind. It was not until 1994, that the International Ice Hockey Federation (IIHF) actually entered it into their rule books. Charles Tator presented the findings from the entire SportSmart registry in 2001 to the NHL physicians. Between 1966 to 1999, SportSmart registered over 401 world wide major spinal injuries, where eight players were known to have died from their injuries sustained while playing hockey. The average age of the players were 18 (46% were 16-20 years old). With this recent data, they concluded that the introduction of the specific rule against hitting from behind has been effective in decreasing the number of severe spinal cord injuries. Checking from behind now only causes 25% of all spinal injuries. Several causative factors have been discussed on the reasons for increased overall major spinal cord injuries. The reasons discussed were an increased aggressiveness and willingness to take risks, a feeling of invincibility, and the lack of awareness of the possibility of spinal cord injuries in hockey.

In 1996, Kevin Stubbington of Windsor Minor Hockey developed the Safety Towards Other Players (STOP) program in hopes of raising awareness of the dangers of checking from behind in the game of hockey. Since 1999, over 385,000 patches have been distributed throughout Ontario and to places around North America such as California, Ohio, Newfoundland, British Columbia, and the Yukon Territory. The patch, as you may have already seen, is placed on the back of the jersey so the other player can see it before they hit from behind. There is now and extensive education course associated with the STOP program, as well as, McDonalds (McStop Program) has now jumped on board in the hope of preventing further hockey injuries. The Ontario amateur hockey groups are currently working on an impact study of the McSTOP Program. The findings were not accessible at the time of printing.