Chronic Diseases and Injuries in Canada

Volume 33 · Number 2 · March 2013

Influence of viewing professional ice hockey on youth hockey injuries

G. Keays, MSc (1); B. Pless, MD (2)

This article has been peer reviewed.

Author references:

  1. McGill University Health Centre, Montreal Children's Hospital, Montréal, Quebec, Canada
  2. Department of Pediatrics, Epidemiology and Biostatistics, McGill University, Montréal, Quebec, Canada Correspondence: Glenn Keays, McGill Health Centre, Montreal Children's Hospital, 2300 Tupper, Room CB-27, Montréal, QC H3H 1P3; Tel.: 514-412-4400 ext 2316; Fax: 514-412-4477; Email: glenn@keays.ca

Abstract

Introduction: Most televised National Hockey League (NHL) games include violent body checks, illegal hits and fights. We postulated that minor league players imitated these behaviours and that not seeing these games would reduce the rate of injuries among younger hockey players.

Methods: Using a quasi-experimental design, we compared 7 years of televised NHL matches (2002–2009) with the year of the NHL lock-out (2004/2005). Data from the Canadian Hospitals Injury Reporting and Prevention Program (CHIRPP) were used to identify the injuries and to ascertain whether they were due to intentional contact and illegal acts including fights.

Results: We found no significant differences in the proportions of all injuries and those involving intentional contact, violations or illegal acts among male minor league hockey players during the year when professional players were locked out and the years before and after the lock-out.

Conclusion: We concluded that not seeing televised NHL violence may not reduce injuries, although a possible effect may have been obscured because there was a striking increase in attendance at equally violent minor league games during the lock-out.

Keywords: adolescent, males, television viewing, violence, sports injuries, hockey

Introduction

''Sure you try what they do. You see them do all sorts of things and get away with it.'' So said a 12-year-old hockey player being interviewed on Canadian television following the blind-side hit that concussed National Hockey League (NHL) star, Sidney Crosby, removing him from play for nearly eleven months. Recent deaths of NHL enforcers—players whose main role is to fight—have fuelled the debate regarding ice hockey violence.

The influence of the media on the behaviour of viewers has been the subject of controversy since the 1950s.Endnote 1–3 In particular, disagreement remains about whether viewing violence on TV has a negative effect on children. In 1975, Rothenberg was convinced by 146 studies ''that violence viewing produces increased aggressive behaviour in the young.''Endnote 4 More recent reports, however, including systematic reviews and meta-analyses, have reached varying conclusions ranging from no effectEndnote 5 to clearly harmful.Endnote 6–11 Nevertheless, the American Psychological AssociationEndnote 12 and the American Academy of PediatricsEndnote 13 assert that the bulk of the evidence points to negative effects.

Although most televised violence seen by children is presented in cartoons or action dramas, it is also evident in many sports broadcasts. Ice hockey, in particular, has a reputation for combining skilful play with aggression. It has the highest rate of sport injuries for boysEndnote 14 and is second only to football as a cause of catastrophic spinal injuries.Endnote 15 The amount of violence typically found on hockey broadcasts is striking: about 40% of NHL games include at least one fightEndnote 16 and about 16% of all severe injuries (e.g. those that force a player to leave the game) are caused by behaviours resulting in a penalty or suspension.Endnote 17 Minor professional hockey leagues, viewed by many as the most violent in hockey, generally have three to four fights per game.Endnote 18 Checking from behind—an action usually associated with severe injuries—only became illegal in 2000,Endnote 19 and there is still controversy about what to do about deliberate hits aimed at the head (''head shots'').Endnote 20 The macho aspect of professional hockey delayed the introduction of helmets until 1979Endnote 21 and continues to delay compulsory visor use.Endnote 22 In minor hockey, both have been obligatory for many years.

The behaviour of children and youth playing in minor leagues seems to be influenced by their watching televised NHL games.Endnote 23–27 A survey showed that 90% reported having learned a ''behaviour, technique or skill'' from watching professional hockey players. In addition, 56% stated they had copied illegal tactics of professional players at least once during the current hockey season.Endnote 28 Another survey indicated that high school hockey players who chose aggressive NHL players as role models were more likely to assault others during games.Endnote 29 More recently, a report commissioned by the ministry of sports in British Columbia noted that 27% of the 144 young hockey players surveyed imitated illegal hits they had seen after watching NHL players.Endnote 30

Accordingly, we concluded there was a reasonable basis for postulating that not watching professional hockey on TV would improve the behaviour of younger players such that there would be fewer injuries. To examine this hypothesis, we took advantage of a natural experiment: during the winter of 2004/2005, owners locked out NHL players during a contract dispute. As a result, except for replays of old NHL games in April 2005 and junior league championship games at the end of May, there was no hockey on Canadian television. We investigated whether the absence of televised professional hockey during this season was associated with a lower rate of injuries among minor league players.

Methods

Our study was restricted to boys playing organized hockey in formal minor leagues in Canada throughout seven successive seasons beginning in 2002/2003. Minor leagues are categorized as peewees, bantams, or midgets according to the age of the players.Endnote 31

We considered only those injuries that occurred during the regular NHL season. The Canadian Hospitals Injury Reporting and Prevention Program (CHIRPP)Endnote 32,Endnote 33 provided details concerning the injuries. CHIRPP is an injury surveillance system situated in 14 emergency departments in seven provinces. It gathers information from parents of patients (or older patients) regarding the circumstances of the injury and includes medical details such as the nature of the injury, the body part and the treatment.

We used several definitions to describe the cause or mechanism of the injury. Initially, we compared all injuries to ''contact-related injuries,'' which include all types of contact, intentional or not. Then, we analysed two specific types of contacts. The first, ''injuries due to illegal contact,'' refers to those cases caused by an illegal hit (or act), as defined by Hockey Canada:Endnote 31 elbowing (extending elbow in a manner to cause injury), cross-checking (using the shaft of the stick to forcefully check an opponent), checking from behind, boarding (checking a defenceless opponent so as to cause him to impact the boards violently), checking to the head, kneeing (leading with the knee to make contact with the opponent), slashing (any forceful or powerful chops with the stick on an opponent's body), tripping (placing the stick, knee, foot, arm, hand or elbow in way that causes the opponent to trip or fall), roughing, or any acts of violence such as fights, altercations and deliberate punches. The second category, ''injuries due to fights,'' includes all injuries resulting from fights, altercations and deliberate punches.

To calculate rates, we obtained from Hockey Canada, for each year of study, the numbers of boys aged 11 to 17 years registered in each of the minor hockey leagues and expressed the proportion as numbers of injuries per 1000 registered male players in this age group in all the cities with pediatric CHIRPP centres. Confidence intervals for individual rates and individual proportions were calculated using the Poisson test.

Results

From September to April in the years 2002 to 2009, CHIRPP reported 14 717 hockey injuries for 11- to 17-year-old boys. Of the injured, 24% were peewees (11- to 12-year-olds), 39% were bantam (13- to 14-year-olds) and 37% were midgets (15- to 17-year-olds). During most years, at each level, about 70% of the injuries were contact related. For all age levels combined, the rates per 1000 registered players varied from 19.0 to 24.9 for any injury and from 13.7 to 18.4 for those judged to be contact related (Table 1). The data do not reveal, however, any pattern or trend over time nor any evidence that the proportion of injuries changed markedly when the lock-out year is compared with the preceding or following years. The same is true when these data are examined for each league or age group.

Although not statistically significant, Table 2 shows a consistent pattern indicating slightly more injuries arising from acts that were judged to be dangerous, that is, intentional or illegal, during the lock-out year.

Figure 1 shows attendance records at minor professional league games before, during and after the lock-out. We reasoned that, deprived of NHL games on TV, avid fans would compensate by attending these games, some of which were televised. The figure clearly shows that there was a peak in attendance at these games during the lock-out; what the figure does not reveal is that many contend that spectators attend these games in part because of their violence.Endnote 34,Endnote 35 Players and coaches of these teams accept that the ''goon'' (who play hockey with an emphasis on intimidation and violence) is part of the games' appeal.Endnote 36,Endnote 37

Discussion

Professional hockey is violent because it relies on aggressive play. In Violence and Sport, SmithEndnote 28 defines aggression as ''any behaviour designed to injure another person, psychologically or physically.'' It is physical violence that typifies much of professional hockey. Robidoux and TrudelEndnote 38 observe that ''body-checking is an example of the regulated use of physical force to gain an advantage … it clearly leads to an increase in injuries.'' Several previous studies suggest that observing the behaviour of professionals during televised hockey matches influences young hockey players.Endnote 25,Endnote 28–30,Endnote 39,Endnote 40 Contrary to what we expected, however, we found no consistent difference between rates of injuries of all kinds when youngsters were not watching NHL games on TV versus seasons when they were. Nonetheless, the belief that young players imitate viewing violence on TV remains plausible and prompted us to search for an explanation.

One explanation is that the behaviours related to youth hockey injuries are so deeply ingrained that they are not likely to change after only one year during which they were not reinforced by viewing the actions of professional players. A second possible explanation is that, by way of compensation, during the lock-out junior players attended more minor professional league games. Paradoxically perhaps, these are widely regarded as even more violent than NHL games,Endnote 34–37 and it is noteworthy, as Figure 1 shows, that there was a striking increase in attendance at these games during the lock-out.Endnote 41,Endnote 42 Thus, exposure to violence may have remained much the same for the entire period of the study.

TABLE 1 Approximate ratesTable 1 - Footnote a of all hockey injuries and contact-related injuries by league (age group) and season per 1000 minor league players (11–17 years), all CHIRPP centres, Canada
Hockey season Registered players, All injuries Contact-related injuries
n n Rates/1000 (95% CI) n Rates/1000 (95% CI)

Sources: Canadian Hospitals Injury Reporting and Prevention Program32; Hockey Canada (www.hockeycanada.ca/index.php/ci_id/23952/la_id/2.htm).

Abbreviations: CHIRPP, Canadian Hospitals Injury Reporting and Prevention Program; NHL, National Hockey League.

Notes: 2004/2005 (bolded) was the year when owners locked out NHL players during a contract dispute. As a result, except for replays of old NHL games in April 2005 and junior league championship games at the end of May, there was no hockey on Canadian television.


aInjuries treated in children's hospital emergency departments do not necessarily parallel the denominator data of registered players. Thus, the rates we used are not ''true'' rates in that the numerators and denominators are from different populations.
PEEWEES (11–12 years)
2002/2003 32561 596 18.3 (16.9–19.8) 440 13.5 (12.3–14.8)
2003/2004 34541 508 14.7 (13.5–16.0) 356 10.3 (9.3–11.4)
2004/2005 32339 492 15.2 (13.9–16.6) 362 11.2 (10.1–12.4)
2005/2006 35492 449 12.7 (11.5–13.9) 322 9.1 (8.1–10.1)
2006/2007 33526 482 14.4 (13.1–15.7) 356 10.6 (9.6–11.8)
2007/2008 32235 525 16.3 (14.9–17.7) 392 12.2 (11.0–13.4)
2008/2009 34354 523 15.2 (14.0–16.6) 378 11.0 (9.9–12.2)
BANTAMS (13–14 years)
2002/2003 30116 939 31.2 (29.2–33.2) 682 22.6 (21.0–24.4)
2003/2004 30448 861 28.3 (26.4–30.2) 624 20.5 (18.9–22.2)
2004/2005 30848 833 27.0 (25.2–28.9) 604 19.6 (18.1–21.2)
2005/2006 33332 761 22.8 (21.3–24.5) 558 16.7 (15.4–18.2)
2006/2007 31249 731 23.4 (21.7–25.1) 535 17.1 (15.7–18.6)
2007/2008 30049 754 25.1 (23.4–26.9) 558 18.6 (17.1–20.2)
2008/2009 32978 854 25.9 (24.2–27.7) 619 18.8 (17.3–20.3)
MIDGETS (15–17 years)
2002/2003 28023 721 25.7 (23.9–27.7) 544 19.4 (17.8–21.1)
2003/2004 28152 837 29.7 (27.8–31.8) 614 21.8 (20.1–23.6)
2004/2005 28597 738 25.8 (24.0–27.7) 562 19.7 (18.1–21.3)
2005/2006 32615 715 21.9 (20.4–23.6) 510 15.6 (14.3–17.0)
2006/2007 32070 813 25.4 (23.7–27.1) 577 18.0 (16.6–19.5)
2007/2008 29963 777 25.9 (24.2–27.8) 570 19.0 (17.5–20.6)
2008/2009 34970 808 23.1 (21.6–24.7) 601 17.2 (15.9–18.6)
ALL PLAYERS (11–17 years)
2002/2003 90700 2256 24.9 (23.9–25.9) 1666 18.4 (17.5–19.3)
2003/2004 93141 2206 23.7 (22.7–24.7) 1594 17.1 (16.3–18.0)
2004/2005 91784 2063 22.5 (21.6–23.5) 1528 16.6 (15.9–17.5)
2005/2006 101438 1925 19.0 (18.2–19.9) 1390 13.7 (13.0–14.5)
2006/2007 96844 2026 20.9 (20.1–21.9) 1468 15.2 (14.4–16.0)
2007/2008 92248 2056 22.3 (21.4–23.3) 1520 16.5 (15.7–17.4)
2008/2009 102302 2185 21.4 (20.5–22.3) 1598 15.6 (14.9–16.4)
Table 2
Proportions of injuries due to illegal acts and fights during organized hockey, by minor hockey league and year, 2002/2003 to 2008/2009
Hockey season All injuries, Injuries due to illegal actsTable 1 - Footnote a Injuries due to fightsTable 1 - Footnote b
n % (95% CI) % (95% CI)

Source: Canadian Hospitals Injury Reporting and Prevention ProgramEndnote 32; Hockey Canada (www.hockeycanada.ca/index.php/ci_id/23952/la_id/2.htm)

Abbreviation: NHL, National Hockey League.

Notes: 2004/2005 (bolded) was the year when owners locked out NHL players during a contract dispute. As a result, except for replays of old NHL games in April 2005 and junior league championship games at the end of May, there was no hockey on Canadian television.


aIllegal acts: hooking, tripping, holding, cross-checking, checking from the back, slashing, elbowing, boarding, checking to the head, kneeing, slashing, roughing.
bFights and altercations.
PEEWEES (11–12 years)
2002/2003 596 22.5 (18.1–26.9) 0.5 (0.0–1.3)
2003/2004 508 16.7 (12.5– 21.0) 0.2 (0.0–0.8)
2004/2005 492 27.4 (22.3–32.7) 1.2 (0.0–2.5)
2005/2006 449 25.4 (20.1–30.7) 0.4 (0.0–1.3)
2006/2007 482 21.8 (17.0–26.7) 0.2 (0.0–0.8)
2007/2008 525 26.5 (21.6–31.5) 0.6 (0.0–1.5)
2008/2009 523 22.9 (18.3–27.7) 0.2 (0.4–0.7)
BANTAMS (13–14 years)
2002/2003 939 17.1 (14.0–20.4) 0.2 (0.0–0.7)
2003/2004 861 13.8 (10.8–16.9) 0.6 (0.0–1.3)
2004/2005 833 18.7 (15.3–22.3) 1.0 (0.1–1.9)
2005/2006 761 18.3 (14.7–21.9) 0.4 (0.0–1.0)
2006/2007 731 18.5 (14.8–22.2) 0.8 (0.0–1.7)
2007/2008 754 16.4 (13.0–20.0) 0.9 (0.1–1.9)
2008/2009 854 17.6 (14.3–21.0) 0.5 (0.0–1.1)
MIDGETS (15–17 years)
2002/2003 721 17.2 (13.6–20.9) 1.9 (0.7–3.3)
2003/2004 837 19.5 (16.0–23.1) 1.9 (0.7–3.2)
2004/2005 738 23.2 (19.2–27.2) 2.7 (1.2–4.3)
2005/2006 715 19.3 (15.5–23.2) 1.3 (0.2–2.4)
2006/2007 813 17.2 (13.9–20.7) 1.6 (0.5–2.8)
2007/2008 777 19.9 (16.3–23.7) 2.1 (0.8–3.4)
2008/2009 808 19.3 (15.8–22.9) 1.6 (0.5–2.8)
ALL PLAYERS (11–17 years)
2002/2003 2256 18.6 (16.5–20.7) 0.8 (0.4–1.4)
2003/2004 2206 16.6 (14.6–18.7) 1.0 (0.5–1.6)
2004/2005 2063 22.4 (20.1–24.8) 1.6 (1.0–2.4)
2005/2006 1925 20.3 (18.0–22.7) 0.7 (0.3–1.3)
2006/2007 2026 18.8 (16.6–21.0) 1.0 (0.5–1.6)
2007/2008 2056 20.3 (18.1–22.7) 1.3 (0.7–1.9)
2008/2009 2185 19.5 (17.4–21.7) 0.8 (0.4–1.4)
Limitations

We acknowledge several limitations. First, CHIRPP data only include a portion of all injuries across Canada, which cannot be regarded as a genuine sample of these injuries. The injuries treated in children's hospital emergency departments do not necessarily parallel the denominator data of registered players. Thus, we accept that the rates we used are not true rates in that the numerators and denominators are from somewhat different populations. However, it is the relative comparisons that we were examining and there is no reason to believe that the relationship changed over the study period.

A second limitation is that there is often insufficient detail in CHIRPP reports to be certain whether an injury was caused by an aggressive or illegal act, and there are missing data. However, all records are coded centrally by trained coders and the information regarding the nature of injury and level of treatment is generally consistent over time. Again, unless there is reason to assume a change in these variables over time, our comparisons are justified.

Figure 1
Attendance records from two minor professional hockey leagues (North American Hockey League and the American Hockey League) between the 2002/2003 and 2008/2009 hockey seasons

Figure 1 Attendance records from two minor professional hockey leagues (North American Hockey League and the American Hockey League) between the 2002/2003 and 2008/2009 hockey seasons
[Figure 1, Text Equivalent]

Chronic Diseases and Injuries in Canada - Volume 33, no. 2, March 2013

Figure 1 shows attendance records from two minor professional hockey leagues games before, during and after the lock-out (North American Hockey League and the American Hockey League) between the 2002/2003 and 2008/2009 hockey seasons. We reasoned that, deprived of NHL games on TV, avid fans would compensate by attending these games, some of which were televised. The figure clearly shows that there was a peak in attendance at these games during the lock-out; what the figure does not reveal is that many contend that spectators attend these games in part because of their violence.

Sources: www.theahl.com, www.lnah.com

Abbreviation: NHL, National Hockey League.

Third, we did not attempt to verify that all our subjects actually watched televised NHL games between 2002 and 2008. However, the Canadian Broadcasting Corporation (CBC) recently announced Hockey Night in Canada as its highest rated show, estimating that 78% of Canadians aged 25 to 54 years watch NHL games.Endnote 43 If we apply the same proportion to our target group of 11- to 17-year-old male adolescents living in Canada and note that NHL hockey games were not only broadcast by the CBC, we can comfortably assume that there are at least one million boys of that age watching the NHL regularly. Moreover, given the extent to which ice hockey is part of Canadian culture, it would be surprising if most games involving home teams were not also watched. In addition, we believe it reasonable to assume that, except for the lock-out season where there was nothing to watch, the proportion of young spectators remained the same over the study years.

Finally, although we cannot be certain that young hockey players were part of the increase in attendance in minor professional leagues during the lock-out, it seems reasonable to assume that they were. Although attendance went up significantly, even if this included children and adolescents it would not come close to the number of children and adolescents who watch televised hockey.

Although not statistically significant based on Jonckheere trend test (p = .099), it is worth noting that the data in Table 1 suggest a small decline in these injuries over time. If true, this development may represent the success of various preventive initiatives or a decreased propensity to go to emergency departments when an injury occurs.

Conclusion

In spite of a reasonable hypothesis, we failed to demonstrate that not viewing the violence that typifies so much of professional hockey has a beneficial effect on the behaviour of young players. Specifically, we found no significant differences in the rates of injuries during one year when professional players were locked out and there were no televised hockey broadcasts. However, the effect may have been partly obscured by compensatory viewing of even more violent junior league games.

Acknowledgments

We thank the CHIRPP directors for providing permission to use data from their hospitals and acknowledge the work of Steven McFaull and Robin Skinner, Health Canada, for making the CHIRPP dataset available to us.

References

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