HEADS UP DON'T DUCK!

How spinal injuries happen in hockey The upper spinal column has a natural curve, which lends flexibility to the head and neck when the head is held in a normal " Heads Up" position (See illustration A). But when the head is flexed (chin toward the chest), this normal curve is removed, and the cervical spine becomes straight, as illustration B demonstrates. In this "head down position," when a player hits the boards or a goal post head on, the head stops suddenly, but the body's movement continues, compressing the spine. This force can produce a shock greater than the neck's discs and muscles can cushion, resulting in a fracture or break of one of more vertebrae. And if one breaks, it can cause compression of the spinal cord, resulting in paralysis below the level of the fracture. According to research done among a wide range of hockey players, almost all on-ice cervical spine injuries have been due to the head being slightly flexed (head down) while making head-on contact with the boards or goal post. A player doesn’t have to be going at full speed for this to happen — it can occur at walking speed. So that's the basis for Rule One of Heads Up Hockey: Heads Up — Don't Duck! 1. Charles H Tator et.al., Spinal Injuries Due To Hockey. Canadian Journal of Neurological Sciences; 11:34-41.

Heads Up, Don't Duck - A Program to Decrease the Risk of Spinal Cord Injuries

Most people do not relate playing ice hockey with spinal cord injuries in the neck -- they don’t happen often. But when a severe injury like a spinal cord injury does occur, the question is: What preventive measures could have been taken?

PLAYERS . . .

• When going into the boards or goal posts, keep your HEADS UP.
• Do not tuck your chin.
• If possible, use your hands, arms, shoulders or facemask to cushion the impact.
• Do NOT check others from behind.

COACHES . . .

• Teach proper ways to give a body check and to take a check.
• Do NOT allow players to check from behind.
• Encourage fair play -- The purpose of body checking is to separate the player from the puck, NOT to separate the player from consciousness!
• Emphasize neck strengthening and flexibility exercises.

PARENTS . . .

• Make sure your child (and your child’s coach) is aware of these techniques to decrease the risk for neck injuries.
• Encourage your child to use the HEADS UP technique.

Can Prevention be Expected?

Prevention is usually possible, and should be the first thought in a player’s mind when entering the rink. Think of the countless hours spent skating, weight training, stretching, competing, and studying the sport, so the player can be prepared when the referee blows the first whistle at the start of the game. Knowing how to protect yourself against spinal cord injury is no different than knowing which goal to score against.

What Kind of Spinal Cord Injury Is Caused?

Cervical (neck) spinal cord injuries, though infrequent, can be devastating. These most often occur when a player lowers his head or tucks his chin to his chest, causing the vertebrae (bone segments of the spinal column that surround the spinal cord) to align in a straight line, and then collides head first into either another player, boards, or goal posts. This force (called axial compression) is transmitted to the aligned vertebrae, and, with minimal force, can result in the fracture, or breaking, of one of the cervical vertebrae. When the vertebra fractures, it can cause compression on the spinal cord, and it is this compression that results in paralysis.

It is rare that this injury occurs when the neck is in a normal or neutral position -- HEADS UP!

Is There Any Type of Protective Equipment?

At present, there is no protective equipment that a player can use to prevent a cervical spine injury. Helmets can protect a player from concussions but do not protect against cervical spinal cord injury.

The best form of protection is to be aware of the danger involved and keep your HEAD UP!

For copies of this brochure, please contact:
The Massachusetts Medical Society Department of Public Health and Education at (781) 434-7373.

Sponsors:
Massachusetts Medical Society
Massachusetts Interscholastic Athletic Association (MIAA)
Massachusetts Hockey
New England Ice Skating Managers Association

Produced by the Massachusetts Medical Society in conjunction with Massachusetts Hockey.

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