Dec. 21, 1999 (Atlanta) -- In the fast, aggressive sport of ice hockey, the number of high-impact collisions has led many colleges to make full-face masks mandatory. However, the nearly simultaneous increase in concussions and neck injuries has sparked a debate. Are the masks creating a 'gladiator mentality' that puts athletes at risk?
In a study published in this week's Journal of the American Medical Association, a group of sports medicine specialists tracked several hundred players' injuries over one season and found that full-face shields have not increased the risk of neck injuries. In fact, they had the added benefit of significantly reducing the risk of facial and dental injuries.
There was no evidence of 'gladiator mentality,' study author Willem H. Meeuwisse, MD, PhD, of the University of Calgary Sport Medicine Centre, tells WebMD in an interview. "We looked at whether overall injury rates were different and they were not. We saw the same amount of aggressive behavior and other injuries [whether they were wearing full or partial shields]."
The study involved 642 male ice hockey players in 22 different teams, all of whom were about 22 years old and playing in the 1997-1998 Canadian Inter-University Athletics Union hockey season. About half the athletes wore full-face shields during the play season, while the other half wore half-face shields.
Of the 319 athletes who wore full-face shields, 195 had at least one injury during the season, while of the 323 who wore half-face shields, 204 were injured.
"Although we found a significant difference in rates of head and facial injuries between the two groups, there was no significant difference in risk of sustaining a concussion, neck, or other injury (overall) for athletes wearing half shields compared with those wearing full-face shields," says Meeuwisse. "Basically, we showed that full-face shields are a good idea and don't have any measurable downside."
The study also found that, for those wearing the half-shield, the risk of facial laceration was nearly 2.5 times greater than with full shields. The risk of dental injury was 10 times higher with half-shields. Time lost from participation because of concussion was significantly greater in those who wore half-shield protection.
While half-shield players were at greater risk of facial lacerations, Meeuwisse points out, those with the full-face shield had lacerations, too -- but they tended to be 'burst' or crush-type injuries at the chin. "With the half-shield, the lacerations tended to be around the mouth and the eye and were potentially a lot more serious."
The number of concussions was not significant, says Meeuwisse, but the severity was worse in players with half-shields. "We didn't look at specifically why, but with the full-face shield, the helmet is actually anchored on the head by the shield because it cups the chin. With the half-shield, it can slip back and expose the forehead."
Facial protection is "one of the most controversial or heated discussion topics in the sport" because the players think it will restrict their vision, says Meeuwisse. "A few players say, 'If I have a full face protector on, I can't see the puck at my feet.'"
"The great thing about this study -- and the reason we're so confident about the results -- is that we had a natural experiment, exactly the same caliber of players, same rules, same officiating, same ice surface, same everything. The only difference was the facial protection," says Meeuwisse, who is also team physician for the National Hockey League's Calgary Flames.
While their results might be applied to high school-level play, "we can't say that's true," says Meeuwisse. "When you get into less mature players, young adults, [the effect] might be different. Full-face shields might have a different effect on an immature neck or an immature head."
Lori Livingston, PhD, associate professor of kinesiology and physical education at Wilfrid Laurier University in Waterloo, Ontario, has also researched the issue. She provided independent commentary on the study for WebMD, calling it "solid work."
"My major comment [is] they could have gone a step further. It's rather disturbing that there were still 34 head and face injuries, even when wearing full-face shield," says Livingston, who has played college-level hockey and coached women's field lacrosse.
The way in which games are officiated should be addressed, she adds. "Because players are wearing equipment, officials tend to be more lenient. We should have very strict rule enforcement. Any injury up around the face should be a penalty."
While officials attempt to control players' behavior, "to be fair to the officials, there are [only] so many things you can control, and you can't anticipate that a player is going to do something illegal. You can see it and react to it, but you can't necessarily stop it from happening. ... Coaches and players need to understand that their attitudes need to be under control as well."
- Because of the aggressive nature of hockey, some colleges are requiring players to wear full-face shields.
- Hockey players who wear full-face shields do not have an increased risk of head and neck injuries and experience fewer facial and dental injuries than those who wear half-face shields.
- One expert says that the number of hockey injuries is still too high, and officials, coaches, and players need to change their attitudes about the sport.