From high-tech helmets to computerized baseline tests, scientists are hard at work devising new ways to tackle the problem of concussions in minor hockey.
But a new study has highlighted the effectiveness of a more rudimentary strategy: changing the rules.
Rules changes can significantly reduce injuries among minor hockey players, and lead to fewer penalty minutes for aggressive acts, according to a study published Monday in the Canadian Medical Association Journal.
Toronto researchers found stricter bodychecking rules led to injury rates that were between three- and 12-times lower.
"Interventions based on rule changes showed the greatest likelihood of making ice hockey safer for youth," lead author Michael Cusimano, a neurologist at St. Michael's Hospital, said in a release.
Concussion and other head injuries are a major concern from the bantam to professional levels. But in youth hockey, the debate around head injuries has centred on bodychecking among pee wee players (ages 11 to 13).
The sport's national governing body, Hockey Canada, has said it is not interested in implementing a national ban on bodychecking at that age.
In October, Hockey Canada president Bob Nicholson told The Globe and Mail he believes it is better for children to be taught how to properly hit at a young age. He also said concerned parents are free to enroll their children in leagues that ban the hits.
But even as concerns about head injuries drive more regions to create leagues that ban the hits, critics say they are mostly recreational, forcing some athletes to choose between safety and their desire to play top-tier hockey. It also creates problems when teams from different streams face each other. (Which almost became the case in Alberta last year, when minor hockey officials in Calgary narrowly defeated a motion to ban the hits in city's pee wee leagues. In Edmonton, the hits are allowed.)
Brain injuries such as concussions, which can result from bodychecking, account for 15 per cent of all injuries to players ages 9 to 16, according to the authors of the CMAJ paper.
The report's authors conducted a literature review, meaning they found 18 other studies that looked at interventions aimed at reducing violence in minor hockey, and assessed them for larger trends. Of the 13 studies that looked at rules changes, 11 showed a reduction in penalties and/or injuries; nine showed a statistically significant decrease.
The findings bolster what safety advocates have been saying for years: prevention is key, and no piece of equipment on the market can protect a child from concussion.
"[The most important thing is] prevention of those concussions by proper adherence to the rules – and some new rules. Head-to-head contact has to be eliminated," Charles Tator, a neurologist and founder of ThinkFirst Canada (which is now a part of safety advocacy group, Parachute) said in an interview.
Last month, Hockey Canada announced it had spent more than $100,000 to create a new smartphone application to help educate parents, coaches and trainers on how to diagnose and treat concussions. The application will be updated as new data emerges.
The CMAJ study also looked at research into the effectiveness of educational programs, but those trends were less conclusive. The three studies that looked at educational interventions showed they led to fewer penalty minutes, but did not account for injury rates.
Nine of the studies looked specifically at bodychecking rules, which led to fewer injuries, penalties, or both.
"Given that brain injuries are so common, and that they can have permanent effects, we need to introduce measures that we know have been shown to work to reduce the numbers of children and youth suffering these injuries in sport," Cusimano said.
"Rule changes essentially alter the culture of a sport and clearly define acceptable behaviour for players, coaches, parents and officials."