The School of Public Health Institute for Athletic Medicine, and Departments of Orthopedic Surgery and Biomechanical Engineering, University of Minnesota, Minneapolis, MN, conducted an epidemiological study of ice hockey injuries among 12 high school varsity teams in the 1982-83 season. A major finding was a high incidence of concussion (9%), accounting for 12% of the total injuries. In addition, dizziness in 34%, headaches in 30%, blurred vision in 12%, and tinnitus in 11%, followed a blow to head or neck. Residual symptoms, including neck pain, back pain, reduced strength in upper extremities, were reported in 28% of players with a blow to head, neck or back. The older, taller, heavier player was injured most frequently, except that the risk to the 14-year old player was equal to that for 18-year olds. Injured players had greater playing experience, and defense and wings accounted for the highest percentage of injuries.
Injuries occurred primarily during competition (82%) and breakout plays accounted for 23% of head injuries. Colliding with another player (35%) and hitting the boards (20%) were the major mechanisms of injury. Playing hockey to allay tension and aggressions resulted in a risk of concussion four times that of alternative motivations such as enjoyment of the game, a scholarship for college, or peer relations. The use of the face mask may have promoted a more aggressive style of play and also increased risk of concussions and other injuries. The authors advocate elimination of body checking, the cushioning of boards, and the use of breakaway goal posts. 
COMMENT: These statistics are alarming. Other studies have shown that one-third of all hockey related injuries have occurred in children aged 5 to 14 years. Epidemiological studies are needed in the younger age groups and Little Leagues. Coaches should be aware that the development of vertebrae and adjoining cartilage is incomplete in children and susceptibility to neck injury is greater than in adults. Coaches, players and parents should be better educated regarding potential risks of serious injuries associated with collision forces to the head and neck in young hockey enthusiasts and aggressive behavior should not be condoned.
Other sports-related CNS injuries in children and adolescents reviewed by Lehman LB  include closed head and cervical spine injuries associated with boxing, wrestling, judo, karate, gymnastics, football, soccer, and rugby. The most important step in reducing cervical spine injury has been the elimination of “spearing”, which involves the use of the helmeted skull as a battering ram. Episodes of mild cerebral concussion, a frequent occurrence in competitive sports, are deleterious. Recently, the cheerleaders “pyramid” formation has been implicated in a number of neurological injuries and even deaths.