Aug. 31, 2004
DOUGLAS G. BROWNING, M.D., ATC-L
WAKE FOREST UNIVERSITY HEALTH SCIENCES
WAKE FOREST UNIVERSITY SPORTS MEDICINE
Hockey is an ancient sport over 4000 years old. It is thought to be the forerunner of all stick and ball games, including baseball, cricket, ice hockey and lacrosse. Known in the United States as Field Hockey, to much of the rest of the world, it=s just hockey. The modern game of hockey is played in 132 countries around the world and is second in popularity as a team sport only to soccer.
Studies have consistently shown that injuries in hockey are numerous and can be serious. Most serious injuries result from being struck by the stick or the ball. A field hockey ball is made of hard plastic, and weighs between 5.5 and 5.75 ounces. When struck forcefully, it may travel at speeds of up to 100 miles per hour.
Most injuries presenting to hospitals are to the face, hands, and lower limb. Fortunately, injuries to the eyes are infrequent, but when they do happen, they tend to be severe.
Methods to prevent hockey injuries include:
Coaching and Expertise of Coaches
The role of the coach is important to injury prevention. Coaches and leaders help to educate players in the fundamental playing techniques of the game, which should include tenets of injury prevention, controlled risk taking and disciplined play.
Coaches should complete at least a basic first aid course, and if available, a sports medicine training program specific to field hockey injuries. Coaches are usually present during training and games and are often the first to respond to an injured player. A coach with knowledge of basic sports first aid will ensure that a player receives prompt medical attention in case of an injury.
Officiating and Expertise of Officials
Rules, and the way that officials interpret them are key elements in sports injury prevention. Determining what constitutes dangerous play is often left to the discretion of the officials, who have a duty of care to participants to ensure their safety during play.
Training for sports officials should include the prevention and management of injuries. Programs need to stress that the health and safety of the participants is the most important factor to be considered in the official's decision making process.
Rules and Penalties
To reduce some of the risk of injury, rules are applied to reduce dangerous play during a match. Rules that limit the use of the stick and the ball reduce the risk of stick and ball type injuries, which are frequently reported. The effectiveness of these rules in reducing injury is dependent on the strict and consistent interpretation by the umpires. Strict penalties should be consistently invoked for deliberate fouls and player dissension. Umpires should be continuously trained so that there is consistent interpretation of rules to minimize unsafe play.
Modified hockey rules for children gives younger players a chance to develop basic skills before progressing to a more competitive level of play. By gradually introducing and developing more formal skills, children=s entry level playing ability is far greater when they start to play hockey with standard rules. Young children should be progressively introduced to hockey through modified and >half-field= hockey. Mandatory protective eyewear should be required for younger players; at least until their skill levels reduce the risk of injury.
The International Hockey Federation (FIH) has adopted a "no blood rule" which states that an injured player must leave the pitch (field of play) in case of an injury that causes bleeding. Players with bloodstains on body or clothing are not to be allowed to start or continue to play in this condition. Wounds must be covered and the bleeding stopped before the player may re-enter the game.
Playing Surface
A safe playing environment can reduce the risk of all injuries, including eye and face injuries. A level playing surface is important, as a rough surface may give rise to unexpected bounces of the ball that may produce trauma to the face and eyes. NCAA Division I field hockey teams usually have the advantage of a smooth artificial playing surface; at the local and junior levels, painstaking and meticulous field maintenance is a must to reduce the risk of injury.
Protective Equipment
Mouthguards are effective in protecting the teeth from fracture, preventing lacerations to the lips and cheeks, decreasing the risk of jaw fracture and reducing the risk of concussion. Mouthguards should be worn by all players during games and training. Mouthguards should be properly fitted and of good quality in order to maximize player comfort and compliance. They should be replaced at the first sign of wear (cracks or splits) or loss of resilience. Mouthguard use should be encouraged at an early age so that it becomes a habit.
The use of protective eyewear is recommended, but requires further investigation to prove its effectiveness in the prevention of hockey eye injuries, before mandatory use can be required. The American Academy of Pediatrics recommends the use of protective eye goggles with polycarbonate lenses for all hockey participants. The goalkeeper is required to wear protective headgear, including a helmet with a full face-mask for eye and face protection, and this rule should be strictly enforced during games and at practices. Unfortunately, field players usually play with no such protection as none is required.
Treatment
Emergency care of hockey injuries to the eyes and face includes immediate rest, ice, compression, elevation and referral (RICER). The RICER method of treatment is believed to reduce the possibility of further damage to the injured soft tissue by reducing the swelling in the area. Players should seek prompt attention for their injuries from a qualified health professional. Organizers of events should ensure that there are qualified professional first aid personnel at all events.
Congratulations to the 2004 Olympic Champions in Field Hockey B the Australian men and the German women. (The United States has never won greater than a bronze medal in Olympic hockey, the only one for women occurring in 1984, and in 1934 for the men B I hope we can change that in Beijing in 2008!).
