Body-Checking in Swedish Women’s Hockey Doubled Injury Claims, Yet Players Back the Rule

When Sweden’s top-flight women’s ice hockey league, the SDHL, permitted body-checking for the first time in 2022, it became the first country in the world to make such a change at the elite female level. Four years on, researchers at Lund University have produced the clearest picture yet of what that decision has meant for player safety, and the findings are striking. In the short term, the number of insurance claims for hockey-related injuries almost doubled, even as the players themselves continue to view the rule change in a positive light.

The first of two recent studies from Lund University draws on insurance data spanning six seasons. All ice hockey-related injuries that led to a claim under the players’ licence insurance were recorded by the insurance company, providing a nationwide, objective measure of injury burden across the league. In the season before body-checking was introduced, the reported injury rate stood at 6.6 injuries per 1,000 player-hours. The following season, the figure surged to 16.7 injuries per 1,000 player-hours, an increase that represents far more than a statistical fluctuation in a league of this size.

The numbers did not remain at that peak. Injury rates fell slightly in subsequent seasons, and the average across the six seasons studied settled at 11 injuries per 1,000 player-hours, compared with an average of 6.0 for the corresponding period before the rule change. Amanda Lahti, a researcher at the Centre for Primary Care Research at Lund University and lead author of both studies, cautions that the long-term trajectory remains uncertain. Injury rates may continue to fall as players adapt to the physical nature of play, but that remains to be seen. She also notes that it is not possible to say with certainty that the higher injury figures are due to body-checking, although she and her colleagues speculate that this is the case, since everything else remains the same compared with previous seasons.

The pattern of injuries offers clues about the mechanisms at work. Shoulder and knee injuries were the most common claims handled by the insurance company, and Lahti speculates that this may be because players take body-checks against the boards with their arms outstretched, a position that loads the shoulder complex and exposes the knee to rotational forces. From a biomechanical standpoint, this is consistent with what is known about board collisions in ice hockey: when a player is checked into the boards with an extended arm, the impact energy is transferred through the glenohumeral joint, while the lower body absorbs unpredictable twisting forces on the ice surface. The apparent levelling-off of the figures could possibly be interpreted, according to Lahti, as players learning to play a more physical game over time, acquiring the positioning, anticipation and body control that male players in checking leagues typically develop from junior levels onward.

The second study took a different methodological approach, drawing on a prospective injury register maintained by the medical staff within the league. Rather than relying on insurance claims, this study identified injuries that resulted in absence from training or matches, giving a clinical picture of the burden that directly affects team availability. A total of 46 match-related injuries were recorded during the study period. The results show that body-checking is now the most frequent cause of injury in the league, and that it is often associated with concussion, which has become the most common type of injury overall.

Two further findings from the clinical register deserve particular attention. First, players often continued to play in games despite being injured: in six out of ten cases of concussion, the player remained on the ice. This is a troubling figure for anyone involved in athlete welfare, since continuing to play with a concussive injury risks second-impact syndrome and prolongs recovery. Second, most of the injuries, including concussions, occurred in the third period, towards the end of the game. Lahti suggests this could indicate that fatigue increases the risk of injury, a well-recognised phenomenon in contact sports, where deteriorating neuromuscular control late in play compromises a player’s ability to prepare for and absorb impacts.

Lahti points out that the explanation for late-game injuries may extend beyond simple tiredness after a tough match. As female ice hockey players generally earn less than their male counterparts, many combine elite sport with paid work, which can limit their recovery and contribute to increased fatigue. She would like to go on and gain a deeper understanding of how sleep and recovery might affect the risk of injury, a question that sits at the intersection of sports medicine, physiology and the social realities of semi-professional women’s sport. Chronic under-recovery, whether driven by compressed schedules, employment demands or insufficient sleep, is increasingly recognised as a modifiable risk factor for both traumatic and overuse injuries.

She is careful to emphasise the limitations of the work. The clinical study tracked the development of injuries over only two years and is based on a relatively small number of injury incidents, which means the results should be interpreted with some caution. Nevertheless, the findings raise important questions and form the basis for further research. Lahti argues that female athletes should not be regarded as “little men”: biological, anatomical and social differences influence the risk of sports injuries, yet only a small proportion of sports medicine research is carried out on women. This makes women-specific studies essential. Although the study has its limitations, she says, it provides important insights and baseline data for the continued monitoring of the cohort and the progression of injuries over time. As a specialist in general medicine and a sports doctor, she works on the prevention of injuries on a daily basis, giving the research a direct clinical grounding.

Perhaps the most intriguing result is a discrepancy at the heart of the findings: the players themselves remain positive about body-checking, and they do not believe it leads to more injuries. This stands in sharp contrast to the objective injury data, which show a marked rise in claims and a new leading cause of injury. Lahti will be examining this mismatch between the players’ own perceptions and the injury data in more detail in a forthcoming paper. Among other things, she has sought the help of a gender researcher from the International Olympic Committee to gain a better understanding of it. The divergence may reflect how athletes weigh the costs and benefits of physical play, how norms within the sport shape perceptions of risk, or how the identity and legitimacy that body-checking confers on the women’s game influence players’ willingness to accept its consequences.

The international significance of the Swedish experiment is considerable. Both the United States and Canada have also recently started to allow body-checking in women’s hockey, and they are keen to know what impact the change has had in Sweden. The Lund studies offer the first rigorous baseline against which other hockey nations can measure their own experience. Lahti’s work has now received a further boost in the form of a grant of SEK 1.2 million from the Dr P Håkansson Foundation, which she describes as very significant and one she hopes will help generate more knowledge that promotes women’s participation in sport at both recreational and elite levels, as well as contributing to the development of the sport. Whether injury rates continue to decline as players adapt, whether concussion prevention measures can blunt the most serious risks, and why players perceive the game as safer than the data suggest, are questions that the coming years of monitoring this unique cohort are expected to answer.

Subject of Research: Effects of legalising body-checking on injury rates in elite women's ice hockey

Article Title: More injuries following the policy change of body-checking in women’s ice hockey – but the players are positive about the change

Article References: More injuries following the policy change of body-checking in women’s ice hockey – but the players are positive about the change. (n.d.). Original publication

Image Credits: AI Generated

DOI: Not provided

Keywords: women's ice hockey, body-checking, SDHL, injury epidemiology, concussion, sports medicine, Lund University, insurance data, athlete recovery, female athletes, Sweden, injury prevention