Ringette: Who Knew?

December 17, 2013 by sportingjim

At CJSM we are already anticipating the start of 2014: the January 2014 issue is still awaiting publication, but we are already releasing some of this coming year’s studies in our “Published ahead of print” collection.

One I wanted to talk about today, if only because the subject sport is an entirely new one to me: Ringette-related injuries in young female players.

Ringette. As a middle-aged guy, I know I still have a lot to learn. That said, I am delighted when I have a day where I acquire some new fact or concept I literally have never encountered in my over 18000 days on the planet. Ringette. I had never heard of this sport until I read this epidemiologic study. Nearly everything I now know about the sport comes courtesy of the authors Glenn Keays, Isabelle Gagnon, and Debbie Friedman. Thanks to you all!

A team sport played on ice rinks, ringette is similar to ice hockey with these notable exceptions: 1) 6 skaters comprise a team; 2) the skaters advance a doughnut shaped ring, rather than a puck, with a stick that has no blade; 3) the rules governing the sport encourage the development of team play; for instance, a player that might be lionized in hockey for being able to single-handedly advance the puck the length of the rink and score is, in ringette, penalized instead. Like competitive women’s ice hockey, ringette is a non-collision sport, with all contact between players officially prohibited. Players are equipped with safety devices such as helmets and visors.

The sport has been around for 50 years, originating in Canada. It is expanding internationally, with associations in the USA, Finland, Sweden and beyond.

In some ways, I am reminded of netball, the modified version of basketball, principally played by women, I have seen enjoyed in New Zealand during some time I have spent there. But I’m sure afficionados of both netball and ringette don’t want to be compared with something else. I would suspect they want to be enjoyed on their own terms.

And such sports need to be understood from a sports medicine point of view on their own terms, as well. The authors of the new CJSM study note that they could find only two other studies of ringette in the medical literature prior to their own. Though it may be tempting, it would not be ideal to extrapolate from what we know about injury patterns in female ice hockey. We need to better understand ringette injury patterns.

And so, the authors looked at the injuries sustained by Canadian girls, age 10 to 17 years, playing organized ringette and presenting to Emergency Departments between 2004 and 2010. They employed the Canadian Hospitals Injury Reporting and Prevention Program (CHIRPP) database. The CHIRPP database has been used widely in the injury prevention literature; for instance, CJSM has published a study looking into the efficacy of bicycle helmets at preventing pediatric head injuries, wherein the authors used data from the CHIRPP database.

The authors report that the majority of injuries (73.8%) were ‘minor,’ and that the head was the body part most frequently injured (31.6%). Injury patterns varied with age. The youngest players (“Atome”, aged 10 – 11 years) suffered more upper extremity injuries than any of the other three, older age groups (Benjamine, Junior, and Cadette). Concussions and suspected concussions comprise a fairly high percentage of the injuries seen, ranging from 22.3% to 32.4% depending on age group. Finally, though prohibited, contact, whether intentional or accidental, is associated with injury in this sport. Overall, 36.4% of the injuries involved no contact with a player (e.g. ice/board), while 29.9% involved incidental contact with a player and one third of all injuries, 33.7%, involved intentional contact with another player.

This finding especially stood out for me, most especially since this is a sport that nominally prohibits contact. The authors state in their discussion that the proportion of intentional contact injuries in ringette is comparable to that seen in female ice hockey, where contact is also prohibited.

I would like to learn more about this sport. For instance, I am left wondering if in organized ringette there is a penalty box, as there is in ice hockey, for people who are guilty of intentional contact. What might we do to reduce the percentage of intentional contact injuries, and lower the overall injury rate in this sport? Are the unintentional contact injuries largely due to people still learning to control their bodies on skates? As for the non contact upper extremity injuries, I wonder how many are FOOSH mechanisms? From the study, I gather that 22.8% of the non contact injuries result in fractures. I wonder what percentage of these might be scaphoid?

As ever, good research like this prompts further questions, sparks further inquiry. I’m looking forward to future studies on this sport. And I’m hoping to catch it live some day so I can see the action first-hand!

Ringette: who knew? I do now!