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- Orthop J Sports Med
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Orthop J Sports Med. 2022 Sep; 10(9): 23259671221117504.
Published online 2022 Sep 8. doi:10.1177/23259671221117504
PMCID: PMC9465570
PMID: 36105655
Charles A. Popkin, MD,
*† Thomas A. Fortney, MD,† Ajay S. Padaki, MD,‡ Andrew J. Rogers, MD,§ David P. Trofa, MD,† T. Sean Lynch, MD,∥ Markku Tuominen, MD,¶ and Michael J. Stuart, MD＃
Author information Article notes Copyright and License information PMC Disclaimer
Associated Data
- Supplementary Materials
Abstract
Background:
Ice hockey referees and linesmen are at risk for musculoskeletal injuriesbecause of the lack of protective equipment and contact with players,sticks, pucks, the ice surface and boards.
Purpose:
To quantify and analyze injuries reported by officials of the InternationalIce Hockey Federation (IIHF).
Study Design:
Descriptive epidemiology study.
Methods:
A 61-question survey tool was designed by an interdisciplinary team toevaluate musculoskeletal injuries experienced by ice hockey officials. Thissurvey was administered to 600 active IIHF referees and linesmen. Onlycompleted survey responses were included in the statistical analysis.Continuous variables were analyzed using unpaired t-tests,while categorical data were assessed utilizing chi-square tests.
Results:
Of the 600 surveys administered, 264 surveys were completed by officials from45 countries (44% response rate). Of the respondents, 72% were male, and 28%were female, with a mean age of 31.1 ± 5.8 years. Officiating experienceaveraged 11.4 ± 6.0 years (6.3 ± 4.5 years with the IIHF). A total of 295injuries were reported by 55% of the officials. Injuries occurred morefrequently during games compared with training, and officials who workedyear-round had more total injuries than those who took time off(P = .03). The most common injuries involved the wristand hand (n = 64 [22%]), head and face (n = 58 [20%]), and the knee (n = 47[16%]). Wrist and hand trauma included 23 fractures. Knee and shoulderinjuries were most likely to require surgery compared with other body areas(P < .001); 30 officials underwent surgery becauseof an acute knee injury (10%). Injury prevention activities were effectiveat reducing injuries (P = .04).
Conclusion:
Most ice hockey officials experienced musculoskeletal injuries during theircareer. The risk of trauma to the wrist and hand can possibly be reduced viaequipment modifications including protective gloves. A greater emphasisshould be placed on injury prevention programs and time away fromofficiating competitions.
Keywords: referees, ice hockey, musculoskeletal injury, injury prevention
Ice hockey is considered one of the fastest and most violent contact sports, resulting ina high potential for injuries.2,22,27 The intrinsic injury risk results from skating at speeds up to 30 mph (48 kph)with razor-sharp skate blades on an ice sheet that is confined by unyielding boards.1,13,30 In addition, a vulcanized rubber puck travels at speeds in excess of 100 mph (161kph). A large body of literature has detailed the incidence, type, mechanism, andseverity of injuries to ice hockey players who compete in these playing conditions.9,22,27,33 However, there is no published literature examining injuries to the officials whor*gulate this fast-paced collision sport.
Sports officials are often an afterthought for casual sports fans unless they disagreewith a call made against their team, but ice hockey referees and linesmen areaccomplished athletes.12 These officials are required to skate at a tremendous pace to keep up with theflow of the game. There are no substitutions or line changes for officials who skatebetween 5 and 10 miles (8-16 km) during a game. The International Ice Hockey Federation(IIHF) has utilized a 4-official system, including 2 referees and 2 linesmen since 2008.One referee is the lead, and the other is the trail. As the flow of the game switchesfrom one end of the ice rink to the other, the trail becomes the lead and vice versa.Referees and linesmen enforce the rules and ensure safe play for all participants on theice.
Ice hockey officials are certainly at risk for musculoskeletal injuries owing to the lackof protective equipment and contact with players, the puck, boards, and sticks. Thesports medicine community has not given ice hockey officials the same attention asplayers. The purpose of this study was to report on the injuries sustained by refereesand linesmen working in IIHF games. Knowledge of these injury patterns will help medicalpersonnel who cover ice hockey games and also guide future research on injury preventionfor these officials. We hypothesized that the majority of ice hockey officialsexperience musculoskeletal injuries during their career.
Methods
After receiving institutional review board approval, we developed a questionnaire forIIHF officials based on the work of Bizzini et al4,5 on soccer referees from the Fédération Internationale de Football Association(FIFA). The final instrument was generated by an interdisciplinary team thatincluded orthopaedic surgeons, sports medicine physicians, athletic trainers, andice hockey officials. The survey was also approved by the IIHF Medical Committee andOfficiating Committee for use.
Unlike soccer14 and rugby,15 which have consensus statements on the definition of injury for theirrespective sports, ice hockey does not have a consensus statement on whatconstitutes an injury.11 We used the IIHF’s definition of a player injury as a reportable event forofficials: “any injury sustained in a practice or game that prevented the player[official] from returning to the ice; any injury sustained in training or a gamethat caused the player [official] to miss a subsequent training session or game; alaceration which required medical attention; all dental injuries; all concussionsand all fractures.”11,34 “Traumatic injuries” were defined as those resulting from a specifictraumatic event, while “overuse injuries” referred to those not associated with aspecified incident.
The 61-question survey (Supplemental Material) was distributed electronically using asecure link to rostered IIHF officials during the 2020 Winter IIHF Meeting.Responses were collected by use of independent survey software (Qualtrics). Allparticipants provided informed consent. The first part of the survey investigatedcharacteristics and officiating experience. The second part focused onmusculoskeletal complaints and injuries sustained while training or officiatinggames. The third part of the survey identified preexisting medical problems (eg,high blood pressure, diabetes, etc). The final section inquired about injuryprevention.
Statistical analysis was conducted utilizing SPSS Statistics Version 25 (IBM). Onlycompleted survey responses were included in the statistical analysis. Continuousvariables were analyzed utilizing unpaired t test. Categorical datawere assessed using chi-square test, measuring the difference between expected andobserved values. The numerical values reported indicate the mean and standarddeviation unless otherwise indicated. Statistical significance was denoted asP < .05.
Results
Of the 600 active IIHF referees and linesmen who were contacted, 264 officials from45 countries completed the survey, for a 44.0% participation rate.19Table 1 summarizes theparticipant characteristics. Of the respondents, 72.0% were male, and 28.0% werefemale, with a mean age of 31.1 ± 5.8 years and a mean body mass index (BMI) of 24.9± 5.8. Overall, 45.1% were referees, 52.3% were linesmen, and 2.7% performed bothroles.
Table 1
Characteristics of Participants (N = 264)a
| Value | |
|---|---|
| Age, y | 31.1 ± 5.8 |
| Sex, n (%) | |
| Male | 190 (72.0) |
| Female | 74 (28.0) |
| Countries represented, n | 45 |
| Height, cm | 177.0 ± 9.7 |
| Weight, kg | 78.7 ± 12.3 |
| BMI | 24.9 ± 5.8 |
| Officiating position, n (%) | |
| Referee | 119 (45.1) |
| Linesman | 138 (52.3) |
| Both referee and linesman | 7 (2.7) |
| No. of years officiating | 11.4 ± 6.0 |
| No. of years officiating in IIHF | 6.3 ± 4.5 |
| No. of IIHF games officiated | 24.1 ± 27.2 |
| No. of IIHF games officiated previous year | 6.1 ± 3.6 |
| No. of non-IIHF games officiated previous year | 66.2 ± 36.2 |
| Training, h/wk | 8.3 ± 5.9 |
| Training schedule, n (%) | |
| Time off | 150 (56.8) |
| Year-round | 114 (43.2) |
| History of injuries, n (%) | 145 (54.9) |
| Consulted physician for injury, n (%) | 105 (72.4) |
| No. of injuries | 2.11 ± 1.04 |
| Injury type (n = 295), n (%) | |
| Traumatic | 264 (89.5) |
| Overuse | 31 (10.5) |
| No. of days injured | 52.4 ± 97.3 |
| No. of days missed from officiating | 22.9 ± 36.3 |
| ≥1 comorbidity, n (%) | 37 (14.0) |
| Musculoskeletal surgery, n (%) | 68 (25.8) |
aData are reported as mean ± SD unless otherwise indicated. BMI,body mass index; IIHF, International Ice Hockey Federation.
This was an experienced cohort of officials. The mean number of years officiating was11.4 years, including 6.3 years with the IIHF. The mean number of IIHF gamesofficiated was 24.1, including 6.1 games during the 2019 IIHF season. Overall, 54.9%(n = 145) of officials reported a history of injuries because of officiating gamesor training. These officials reported a total of 295 injuries, of which 89.5% (n =264) were traumatic and 10.5% (n = 31) occurred from overuse. Additionally, 72.4% (n= 105) of these officials sought the care of a physician for their injury. Onaverage, they missed 22.9 days from officiating with each injury.
Further, 14.0% (n = 37) of officials reported at least 1 medical comorbidity, whichincluded seasonal allergies (n = 15), asthma (n = 10), hypertension (n = 6), kidneydisease (n = 2), diabetes (n = 2), hypothyroidism (n = 1), and bradycardia (n = 1).Notably, 25.8% (n = 68) of officials required musculoskeletal surgery, and 43surgical procedures were a direct result of an injury sustained while officiating onthe ice.
Comparison of Referees and Linesmen
Table 2 summarizesthe respondent characteristics by sex and officiating position. The mean age ofmale referees (n = 100) was 33.9 years, and the mean BMI was 25.9. They had amean of 13.3 years of officiating experience, with 7.42 years of officiatingwith the IIHF. The mean age of male linesmen (n = 90) was 29.5 years, with amean BMI of 25.2, a mean of 10.8 years of officiating experience, and 5.77 yearsof officiating with the IIHF. Of all male officials (combined referees andlinesmen), 55.0% reported an injury in their career, for a mean of 2.12 injuriesper official.
Table 2
Comparison by Sex and Officiating Positiona
| Overall | ||||
|---|---|---|---|---|
| BMI | Age, y | No. of Years Officiating | No. of Years Officiating in IIHF | |
| Referees | ||||
| Male (n = 100) | 25.9 ± 3.82 | 33.9 ± 5.02 | 13.3 ± 5.69 | 7.42 ± 4.39 |
| Female (n = 24) | 23.3 ± 1.89 | 31.5 ± 6.51 | 13.6 ± 8.12 | 7.84 ± 6.45 |
| Linesmen | ||||
| Male (n = 90) | 25.2 ± 2.33 | 29.5 ± 5.01 | 10.8 ± 4.91 | 5.77 ± 3.69 |
| Female (n = 50) | 23.5 ± 2.72 | 27.4 ± 5.18 | 8.2 ± 5.30 | 4.30 ± 3.79 |
| By Sex | ||||
| No. of Years Officiating in IIHF | No. of IIHF Games Officiated Last Year | History of Injuries, % | No. of Injuries | |
| Male (n = 190) | 6.42 ± 4.06 | 6.34 ± 3.16 | 55.0 | 2.12 ± 1.14 |
| Female (n = 74) | 5.52 ± 4.65 | 6.92 ± 4.51 | 51.3 | 2.05 ± 1.03 |
| P value | .15 | .21 | .35 | .75 |
| By Officiating Position | ||||
| Training, h/wk | Time Off, % | Injuries Reported, % | Injuries in Career, n | |
| Referees (n = 124) | 8.39 ± 5.44 | 50.0 | 55.8 | 2.18 ± 1.16 |
| Linesmen (n = 140) | 8.25 ± 6.37 | 54.1 | 52.7 | 2.05 ± 1.05 |
| P value | .44 | .71 | .23 | .22 |
aData are reported as mean ± SD unless otherwise indicated.BMI, body mass index; IIHF, International Ice Hockey Federation.
The mean age of female referees (n = 24) was 31.5 ± 6.51 years, and the mean BMIwas 23.3 ± 1.89. They reported a mean of 13.6 ± 8.12 years of officiatingexperience, with 7.84 ± 6.45 years of experience working IIHF tournaments.Female linesmen (n = 50) had a younger mean age than female referees at 27.4 ±5.18 years and a mean BMI of 23.5 ± 2.72. They reported 8.2 ± 5.30 years ofofficiating experience, with 4.30 ± 3.79 years officiating in IIHF games.Overall, 51.3% of female officials reported an injury, with a mean 2.05 ± 1.03reported injuries.
No difference in the number of injuries was noted when comparing male versusfemale officials (2.12 ± 1.14 vs 2.05 ± 1.03 injuries, respectively;P = .75) or when comparing referees to linesmen (2.18 ±1.16 vs 2.05 ± 1.05 injuries, respectively; P = .22) (Table 2). Whenstratified by age, officials aged ≥30 years had a significantly larger number ofreported injuries than those aged <30 years (2.22 ± 1.19 vs 1.93 ± 1.08injuries, respectively; P = .047). However, when stratified byBMI, there was no difference in the number of injuries between officials with anormal BMI, defined as <25, and those with an elevated BMI (2.10 ± 1.07 vs2.14 ± 1.15 injuries, respectively; P = .41) (Table 3).
Table 3
Effect of Age and BMI on Injuriesa
| Training, h/wk | History of Injuries, % | No. of Injuries | |
|---|---|---|---|
| Age | |||
| <30 y | 8.10 ± 4.72 | 50.4 | 1.93 ± 1.08 |
| ≥30 y | 8.31 ± 6.33 | 57.8 | 2.22 ± 1.19 |
| P value | .77 | .10 | .047 |
| BMI | |||
| <25 (n = 141) | 7.88 ± 4.39 | 56.0 | 2.10 ± 1.07 |
| ≥25 (n = 123) | 8.70 ± 6.77 | 51.2 | 2.14 ± 1.15 |
| P value | .22 | .24 | .41 |
aData are reported as mean ± SD unless otherwise indicated.BMI, body mass index. Bold indicates significance of <.05.
Injuries by Body Area
The 295 reported injuries were divided into 9 categories according to the area ofinjury (dental; wrist and hand; head and face; chest and stomach; knee and leg;groin, hip, and pelvis; back; foot and ankle; and shoulder and elbow) (Figure 1 and Table 4). Injuries tothe wrist/hand were the most common (n = 64), followed by the head/face(concussions and lacerations, n = 58) and knee/lower leg (n = 47). There were 43reported surgeries; 30 of the surgical procedures involved the knee, 12 surgicalprocedures were performed on the shoulder and elbow, and there was 1 hipprocedure. A knee or shoulder injury had the highest likelihood of requiringsurgery compared with the remaining body areas (P <.001).
Table 4
Injuries According to Body Area (n = 295)a
| Injuries, n | Surgery Needed, n | No. of Days Injured | No. of Days Missed From Officiating | |
|---|---|---|---|---|
| Dental | 24 | 0 | 39.6 ± 48.3 | 5.6 ± 8.1 |
| Wrist/hand | 64 | 0 | 80.5 ± 112.5 | 18.8 ± 22.4 |
| Head/face | 58 | 0 | 19.8 ± 32.8 | 13.2 ± 19.6 |
| Chest/stomach | 18 | 0 | 39.1 ± 54.8 | 43.6 ± 49.8 |
| Knee/lower leg | 47 | 30 | 64.5 ± 104.3 | 42.5 ± 73.7 |
| Groin/hip/pelvis | 15 | 1 | 82.0 ± 97.5 | 12.1 ± 14.4 |
| Back | 17 | 0 | 203.5 ± 191.2 | 21.1 ± 19.3 |
| Foot/ankle | 29 | 0 | 70.6 ± 87.8 | 39.8 ± 41.9 |
| Shoulder/elbow | 23 | 12 | 59.0 ± 81.3 | 22.9 ± 32.5 |
aData are reported as mean ± SD unless otherwise indicated.There was a significant difference in injuries that required surgerybetween knee and shoulder injuries and injuries to other body areas(P < .001).
Wrist and hand injuries (Table 5) included 23 fractures (35.9%), 16 contusions (25.0%), 8lacerations (12.5%), 5 dislocations (7.8%), 5 ligament or tendon injuries(7.8%), and 7 categorized as other (10.9%).
Table 5
Types of Wrist/Hand Injuries (n = 64)
| n (%) | |
|---|---|
| Fracture | 23 (35.9) |
| Contusion | 16 (25.0) |
| Laceration | 8 (12.5) |
| Other | 7 (10.9) |
| Joint dislocation | 5 (7.8) |
| Ligament/tendon injury | 5 (7.8) |
Injury Prevention Activities
Referees and linesmen both made injury prevention a priority, with 88.6% ofsurveyed officials engaging in injury prevention activities. Only 30 (11.4%) ofthe surveyed officials did not do anything specific to minimize injuries on thejob. More than half (n = 144 [54.5%]) of the surveyed officials participated ina stretching or flexibility program to help minimize injuries, an almost equalnumber utilized a personal trainer (n = 35 [13.3%]) or physical therapist (n =36 [13.6%]), and 19 officials (7.2%) made use of massage therapy as an injuryprevention option.
There was a significant difference in the number of injuries according to thetraining schedule. Officials who took time off from training had significantlyfewer injuries than those who trained year-round (2.01 ± 1.05 vs 2.27 ± 1.18injuries, respectively; P = .031). However, 50.9% of officialswho trained for <10 h/wk sustained an injury compared with only 40.5% ofofficials who trained for ≥10 h/wk (P = .026) (Table 6).
Table 6
Injuries According to Injury Prevention and Traininga
| History of Reported, % | No. of Injuries | No Surgery Needed, % | |
|---|---|---|---|
| Injury prevention | |||
| Yes (n = 234) | 50.9 | 2.14 ± 1.17 | 75.0 |
| No (n = 30) | 65.5 | 1.95 ± 0.89 | 70.0 |
| P value | .043 | .13 | .37 |
| Training schedule | |||
| Time off | 54.1 | 2.01 ± 1.05 | 75.3 |
| Year-round | 56.2 | 2.27 ± 1.18 | 73.2 |
| P value | .36 | .031 | .25 |
| Training | |||
| <10 h/wk | 50.9 | 2.17 ± 1.14 | 74.0 |
| ≥10 h/wk | 40.5 | 2.08 ± 1.08 | 75.0 |
| P value | .026 | .31 | .68 |
aData are reported as mean ± SD unless otherwise indicated.Boldface P values indicate a statisticallysignificant difference between groups (P <.05).
Discussion
Ultimately, 54.9% (n = 145) of surveyed IIHF officials reported an injury, of which89.5% (n = 264) were traumatic and 10.5% (n = 31) occurred from overuse.Additionally, 72.4% (n = 105) sought care from a physician for their injury. Onaverage, officials missed 22.9 ± 36.3 days from competition with each injury. Themost common injuries involved the wrist and hand (21.7% [n = 64]), head/face (19.7%[n = 58]), and the knee (15.9% [n = 47]). Wrist and hand trauma included 23fractures. Knee and shoulder injuries were most likely to require surgery(P < .001). Further, 30 (10.2%) surgical procedures wereneeded because of an acute knee injury. Injury prevention was effective for riskreduction (P = .043). Referees and linesmen who worked year-roundhad more injuries than those who took time off (P = .031).
Our survey investigated musculoskeletal injuries in a cohort of IIHF referees andlinesmen from 45 different countries. These ice hockey officials were younger (meanage, 31.1 ± 5.8 years) than referees in elite soccer and Gaelic football.4,6,23,29 The mean BMI (24.9 ± 5.8) of the surveyed ice hockey officials was similar tothat in previous studies of soccer officials (mean, 23-26).4,21,23,29 A BMI of 25 has been used in previous work to correlate with performance andhealth in officials.8
IIHF referees and linesmen demonstrated a 54.9% career injury prevalence in ourstudy, slightly higher than what has been reported for referees in elite soccer leagues.4 Bizzini et al,4 in a study of top-level Swiss soccer referees, found a 40% career injuryprevalence in their surveyed officials. Another study of female soccer officials,looking at referees and assistant referees at the 2007 FIFA Women's World Cup, founda 48% career incidence of injuries.3 The annual injury rate was reported as 58% for Gaelic football officials, 52%for hurling officials, and 42% for officials covering both sports.6
The anatomic locations and types of injuries in our study were unexpected and did notfollow the findings of any previous studies on referees. The most frequentlyreported injuries were to the wrist, hand, and finger (n = 64), followed by injuriesto the head/face (concussions, lacerations; n = 58) and injuries to the knee/leg (n= 47). In a study of top-level Croatian soccer officials, calf strains and anklesprains were the most common injuries during competition, with quadriceps andhamstring strains occurring during fitness training.17 Gaelic sports officials had a high injury rate in the lower limbs, withhamstring and calf strains being the most commonly reported.6 In a study of Swiss soccer officials, hamstring strains and ankle sprainswere the most commonly reported injuries.4
The injury breakdown reported by the officials in this study was also inconsistentwith published research on injuries in ice hockey players. A recent epidemiologystudy looking at Swiss ice hockey teams found the most injuries to involve the hipand groin, followed by concussions.7 A study of ice hockey players at the IIHF World U20 and U18 Championshipsidentified a high percentage of head/face injuries (lacerations and concussions) inthe U20 group.34 The shoulder was the most commonly injured area in the U18 group.34 Concussions were the most common National Collegiate Athletic Associationmen’s hockey injuries, followed by medial collateral ligament sprains andacromioclavicular joint contusions.13 Another study of ice hockey injuries from the IIHF Men’s World Championshipsand Olympic Games identified injuries to the head/face, medial collateral ligament,and acromioclavicular joint as the most common body regions.33
The most straightforward explanation for the high incidence of hand and wristinjuries in the officials in our study is the lack of protective gloves duringcompetition. The most common hand or wrist injury was a fracture (Table 5). The literatureon hand and wrist injuries in ice hockey is limited.2,18,25,31 Finger contusions and wrist sprains were reported in an epidemiology study ofmen’s and women’s collegiate hockey players.25 Another study found that hand, wrist, and elbow injuries comprised roughly14% of hockey-related visits to the emergency department.10
A high percentage of knee injuries (63.8%) in our series required surgery (n = 30).Previous work on Premier League soccer referees found that 81% of officialssustained a knee injury at some point during their career.23 Further research to determine the exact mechanism and type of knee injuriescan help guide prevention strategies.
More than half of IIHF officials engaged in injury prevention activities, including astretching or flexibility program, use of a personal trainer, physical therapy, andmassage therapy. The IIHF referees who did not engage in injury preventionactivities were more likely to sustain an injury (65.5% vs 50.9%, respectively;P = .043). Furthermore, ice hockey officials who workedyear-round without time off had more injuries than those who took dedicated breaks(2.27 ± 1.18 vs 2.01 ± 1.05 injuries, respectively; P = .031). Thedangers of specialization and overtraining are well documented in the literature.26,28,38 The number of weekly training hours also affected the injury risk, as 50.9%of officials who worked out for <10 h/wk sustained an injury as opposed to 40.5%of officials who worked out for ≥10 h/wk (P = .026). Injuryprevention strategies and taking time off from officiating may help to reduce theinjury risk. Some of these injury prevention tactics have been reported in otherstudies involving soccer referees.4
Notably, only 72.4% (n = 105) of injured officials (n = 145) sought care from aphysician for their injuries. This may be because of officials receiving care fromathletic trainers or other members of the medical staff. However, this may alsoindicate barriers to officials accessing care from physicians. While professionaland international ice hockey teams often work closely with a designated teamphysician, ice hockey officials are not provided with a designated physician. Thisis a potential area for improvement with the development of a protocol for injuredofficials to undergo an evaluation by a physician. The IIHF has recommended addingofficials to its Injury Reporting System, which may improve injury identificationand access to care. Additionally, the IIHF may consider recruitment of an additionalphysician to provide medical care for officials during IIHF events.
Limitations
There are limitations to this study. First, the overall participation rate waslower than desired at 44.0% (264/600). Although response rates of ≥70% aredesirable for external validity, a lower response rate may be acceptable.32 Visser et al37 demonstrated that studies with response rates as low as 20% provided moreaccurate results than studies with response rates of 60% to 70%. A recent cohortstudy demonstrated that, despite low response rates (18%-60%) and different datacollection methods, results were remarkably consistent.24 Still, this represents the second largest study on officials in theliterature, as Gabrilo et al17 reported on 342 Croatian soccer referees. A language barrier may havecontributed to the lower response rate, as the survey was only available inEnglish. Second, the retrospective design could have introduced recall bias.Several publications have questioned the accuracy of self-reported injury studies.4,20,36 A comparison of prospective and retrospective injury studies inAustralian rules football over a 12-month period showed that recall accuracysignificantly declines at 1 year.16 Only 80% of the athletes were able to remember the number of injuries andthe particular body parts involved. A comparison of prospective surveillancewith retrospective recall in physical education students in the Netherlandsfound that participants did not recall >50% of their recorded injuries.35 This would seem to suggest that the present study likely underestimatedthe true number of injuries in ice hockey officials. Third, we did notspecifically define time away from year-round training in the survey question.The individual interpretation of the question could have resulted in a widerange of values from a couple of weeks to a couple of months. This appliedspecifically to the injury risk for officials who trained and worked year-roundwithout any dedicated time away from the sport. Last, it is possible that someofficials did not disclose an injury to avoid the loss of IIHF officiatingopportunities.
Conclusion
The majority of ice hockey officials experienced musculoskeletal injuries duringtheir career. Knowledge of injury patterns in ice hockey officials will help medicalpersonnel diagnose and treat injuries in this unique population and guide futureresearch on injury prevention. The risk of trauma to the wrist and hand couldpossibly be reduced via equipment modifications including protective gloves. Agreater emphasis should be placed on injury prevention programs, and officialsshould be encouraged to intermittently take time away from the ice. We support theIIHF recommendation to add officials to its Injury Reporting System.
Supplemental material for this article is available at http://journals.sagepub.com/doi/suppl/10.1177/23259671221117504.
Supplemental Material
Supplemental Material, sj-pdf-1-ojs-10.1177_23259671221117504 - Injuriesto Ice Hockey Referees and Linesmen: A Survey of International Ice HockeyFederation Officials:
Click here for additional data file.(146K, pdf)
Supplemental Material, sj-pdf-1-ojs-10.1177_23259671221117504 for Injuries to IceHockey Referees and Linesmen: A Survey of International Ice Hockey FederationOfficials by Charles A. Popkin, Thomas A. Fortney, Ajay S. Padaki, Andrew J.Rogers, David P. Trofa, T. Sean Lynch, Markku Tuominen and Michael J. Stuart inOrthopaedic Journal of Sports Medicine
Acknowledgment
The authors acknowledge and thank the IIHF Officiating and Medical Committees fortheir help and support in making this study possible. The authors also highlyappreciate the cooperation of all the referees and linesmen in the IIHF who took thetime to complete the survey.
Footnotes
Final revision submitted March 12, 2022; accepted May 17, 2022.
One or more of the authors has declared the following potential conflict ofinterest or source of funding: C.A.P. has received research support andeducation payments from Arthrex. A.J.R. has received education payments fromArthrex; consulting fees from DePuy/Medical Device Business Services, Linvatec,and Smith & Nephew; speaking fees from Arthrex; and hospitality paymentsfrom Stryker. D.P.T. has received research support from Arthrex and educationpayments from Arthrex and Smith & Nephew. T.S.L. has received educationalsupport from Linvatec and Smith & Nephew and consulting fees from KCI andSmith & Nephew. M.J.S. has received research support from Stryker andconsulting fees, speaking fees, and royalties from Arthrex. AOSSM checks authordisclosures against the Open Payments Database (OPD). AOSSM has not conducted anindependent investigation on the OPD and disclaims any liability orresponsibility relating thereto.
Ethical approval for this study was obtained from Columbia University (protocolNo. AAAR2657).
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