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ABSTRACT
MURTAUGH, K. Injury patterns among female field hockey players. Med. Sci. Sports Exerc., Vol. 33, No. 2, 2001, pp. 201207.
Purpose: To examine injury patterns among female field hockey players and to broaden the current base of knowledge by identifying
the injury rates of different playing positions. It was hypothesized that goalkeepers would have the highest rate of injury, followed by
forwards. Methods: High school, university, and national level female field hockey players (N 158) completed an anonymous
questionnaire. They reported personal characteristics (age, height, weight); field hockey information (level, years of experience,
surface); injury history (type, site, cause, severity); and back pain information. Injury rates were calculated per athlete-year. Results:
The most frequently injured site of the body was the lower limb (51%), followed by the head/face (34%), upper limb (14%), and torso
(1%). The most prevalent types of injuries were ankle sprains, followed by hand fractures and head/face injuries. Goalkeepers had the
highest rate of injury (0.58 injuries/athlete-year), whereas midfielders were the most injured field players (0.36 injuries/athlete-year).
Back pain was reported by 59% of the sample, and the lower back was the most common site of this pain. Conclusion: There are
differences in the rates of injury among playing positions in field hockey and in the types of acute injury sustained at each position.
The high number of injuries to the head and face region is also cause for concern. Although most of these injuries are minor, the serious
injuries that do occur can be very severe. Now that these patterns have been identified, further examination of the playing situations
that lead to injury should be undertaken. Key Words: SPORT, TRAUMA, ACUTE INJURY, EPIDEMIOLOGY
201
FIGURE 1Many players crowd the goal area while the goalkeeper
is in a vulnerable position during a high school game (photograph
copyright of S. Spaulding, 1999).
RESULTS
Of the 158 athletes surveyed, 49% reported that they
regularly trained and played on artificial turf, 21% participated on grass, and 30% indicated that they used both
surfaces equally. At least one acute injury that had occurred
during a field hockey game or practice was reported by
74.7% of these athletes. The injured athletes had an average
age of 20.4 (3.2) yr and 7.4 (3.3) yr of experience. The
uninjured athletes (N 40) were significantly younger and
had less experience with an average age of 18.0 (2.6) yr
and 5.4 (3.5) yr of experience (P 0.05).
Approximately half of the 469 injuries that occurred were
to the lower limb. The next most frequent site of injury was
the head/face area, followed by upper limb and torso (Fig.
2). The most common type of injury was a ligament sprain
(39.7% of total injuries) and most of these were ankle
sprains (Fig. 3). Because these sprains were self-reported,
the severity could not be assessed. Other prevalent injuries
were contusions and fractures (17.1% and 16.4%, respectively). Most contusions occurred to the head/face region,
whereas most of the fractures involved bones of the wrist or
hand. Of the remaining 26.9% of the injuries, 9.4% were
wounds, 8.1% were muscle strains, 7.7% were concussions,
and, finally, 1.7% were dislocations.
203
TABLE 1. Personal characteristics of the female field hockey players in the sample, categorized according to the position played.
Age (yr)
Experience (yr)
Height (m)
Mass (kg)
Goal
(N 11)
Backfield
(N 44)
Midfield
(N 27)
Forward
(N 46)
Multiple
(N 30)
Total
(N 158)
20.4 (3.8)
8.1 (4.0)
1.68 (0.05)
65.3 (13.0)
19.3 (2.9)
6.7 (3.6)
1.64 (0.06)
61.7 (9.7)
20.0 (3.6)
6.8 (2.9)
1.65 (0.05)
61.1 (6.1)
19.6 (3.0)
6.3 (2.9)
1.63 (0.09)
60.3 (5.9)
20.4 (3.7)
7.4 (4.3)
1.64 (0.07)
60.8 (5.8)
19.8 (3.25)
6.8 (3.5)
1.64 (0.07)
61.3 (7.8)
TABLE 2. The number of specific traumatic injuries sustained by female field hockey players (N represents the number of players surveyed at each position).
Head/face
Bruise/black eye
Wound
Concussion
Broken nose
Dislocation
Total head/face
Upper limb
Fracture
Ligament sprain
Dislocation
Bruise
Wound
Total upper limb
Torso
Fracture
Muscle strain
Total torso
Lower limb
Ankle sprain
Muscle strain
Knee injury
Fracture
Bruise
Wound
Total lower limb
204
Goal
(N 11)
Backfield
(N 44)
Midfield
(N 27)
Forward
(N 46)
Multiple
(N 30)
Total
(N 158)
4
1
12
1
0
18
11
3
5
2
0
21
16
16
2
3
1
38
21
9
10
4
0
44
18
11
7
4
0
40
70
40
36
14
1
161
9
1
0
1
0
11
7
3
0
1
0
11
10
2
2
0
1
15
8
2
2
1
0
13
11
1
1
0
1
14
45
9
5
3
2
64
3
0
3
0
1
1
0
0
0
0
0
0
0
1
1
3
2
5
6
6
5
2
1
0
20
57
3
6
5
1
1
73
21
7
4
2
1
0
35
31
13
1
4
2
0
51
43
9
3
2
2
1
60
158
38
19
15
7
2
239
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DISCUSSION
The general pattern of field hockey injuries presented in
this study supports the findings of other authors. The most
frequent site of injury was the lower limb, followed by the
head and face, upper limb, and finally the torso (8,18,19,21).
An ankle sprain was the most common single injury. This
result is not unique to field hockey as the lateral ankle is the
most frequently injured area in the body, and, overall, an
ankle sprain is the most common injury in sport (7,25).
Whether the mechanism of injury in field hockey is the same
as in other field sports, such as soccer, has yet to be determined. Fox (6) suggests that the stooped position used when
dribbling the ball may be an unsound position for fast
locomotion and could contribute to lower limb injury.
It is interesting to note that studies conducted before 1980
have reported lower incidences of upper limb injuries than
more recent reports. Graham and Bruce (8) surveyed intercollegiate athletic injuries during the 1974 75 school year
in Virginia and found 10.6% of total injuries to the upper
limb, and Rose (21) reported 4.9% at the California State
TABLE 3. Reports of back pain in female field hockey players.
Players
Reporting
Experience of pain
At any time
During season
Injury
Effects of pain
Affects performance
Missed games
Missed practice
Missed school or work
Site of pain
Neck
Upper back
Ribs
Lower back
Tail bone
59%
50%
31%
24%
8%
15%
7%
15%
19%
6%
54%
12%
University in Long Beach from 1976 to 1979. Recent surveys of collegiate and high school field hockey (including
the current study) indicate that 14.0% to 15.8% of the total
injuries are to the upper limb and most of these are wrist or
finger fractures (18,19). It is possible that this difference is
due to changes in the game that have occurred over the past
two decades. For example, improved stick construction allows players to hit the ball with greater velocity and different techniques for stopping the ball on artificial turf may
have led to an increased risk of upper limb injury.
The second most frequent site of injury in field hockey is
the head and face region. The percentage of athletes who
had sustained at least one injury to this area was 42%, and
the uninjured players tended to be younger and have less
experience than injured players. Because only active players
were surveyed, these findings do not include those who may
have stopped playing due to serious or catastrophic injury.
It appears that if an athletes play long enough, they are likely
to experience a head or face injury. This statement is supported by a survey conducted on international athletes (1). It
was found that 62% of these elite level athletes had a facial
injury at least once, and the high value was attributed to their
increased exposure time and tendency to take more risks.
Although no catastrophic injuries were reported in this
study, the high rate of injury to the head and face region
indicates that the potential for such injury still exists. Elliott and
Jones (4) reported three penetrating eye injuries to female field
hockey players in one season. All of these injuries were caused
by a stick, as were 36% of the head and face injuries in this
study. Findings such as these have led to the suggestion that a
helmet with a full visor be required in field hockey. Yet, this
study found that goalkeepers, who are already wearing helmets, had the highest rate of concussions. If protective equipment is deemed necessary, the impact of equipment changes on
potential injuries, as well as the character and nature of the
game, must be carefully considered (10,11).
With the above concerns in mind, a more immediate
approach to reducing severe injury would include education
about the risks of head and eye injury and strict enforcement
of the current rules. For example, a recent survey indicated
that parents saw a need for the mandatory use of mouthguards in field hockey (3). Mouth protectors have been
shown to decrease concussions, cerebral hemorrhages, unconsciousness, jaw fractures, and lacerations of the lips and
cheeks (9,16). Despite these benefits and widespread regulations enforcing the use of mouthguards, many players still
do not wear them (1). The most common reason that was
cited for not wearing the protector was discomfort. Also,
most of the players who wore the mouthguard did so because they had already sustained an injury.
Rules governing the use of the stick and acceptable ways
of playing the ball are in place to reduce dangerous play
during a match. Yet, the NCAA reports that only 16.3% of
total injuries in the 1998 99 season were due to illegal
action (18). Clearly, most injuries occur during play that is in
accordance with the current rules. This risk has severe implications for children and young players, who need to develop
basic skills before progressing to a more competitive level of
Medicine & Science in Sports & Exercise
205
FIGURE 6 The player in the white shirt chases down a player with
the ball. Note that great care must be taken to avoid the stick should
the offensive player decide to drive the ball (photograph copyright of
J. Mahannah, 1999).
CONCLUSIONS
This study demonstrated that the most prevalent injuries
in field hockey are ankle sprains, hand fractures, and head or
face injuries. It also revealed that, not only is there a difference in the rate of injury between playing positions, but
also in the types of injuries sustained at different positions.
Most of these injuries are not severe. In fact, field hockey
tends to have low serious injury rates when compared with
other sports. In the NCAA, field hockey was fourth among
the womens sports covered, behind gymnastics, soccer, and
basketball (18). Of five popular high-school sports played
by girls (including basketball, field hockey, soccer, softball,
and volleyball), field hockey had the lowest number of
injuries requiring surgery or more than 7 d of time lost (19).
Yet, the nature of severe injuries in field hockey and the
high rate of head/face injury indicate a serious risk. Now
that these patterns have been identified, further examination
of the playing situations that lead to injury should be undertaken. It seems that reducing these types of injuries will
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ding for their constructive criticism and expert advice throughout the
data collection and writing process.
Conclusions drawn from or recommendations based on the data
provided by the National Collegiate Athletic Association are those of
the author based on analyses/evaluations of the author and do not
represent the views of the officers, staff, or membership of the
NCAA.
Address for correspondence: K. Murtaugh, 2142 Thames Hall,
The University of Western Ontario, London, Ontario, N6A 3K7, Canada; E-mail: murtaugh@julian.uwo.ca.
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