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Indian Journal of Physiotherapy and Occupational Therapy

A Survey of Injuries in Field Hockey Players in Relation to Playing Surface

Author(s): Kawaldeep Kaur, Vikram Singh Yadav, Jaspal Singh Sandhu

Vol. 2, No. 3 (2008-07 - 2008-09)

Kawaldeep Kaur, Vikram Singh Yadav, Jaspal Singh Sandhu

Department of Sports Medicine and Physiotherapy, Guru Nanak Dev University, Amritsar (Punjab) India – 143 001

Abstract

Introduction

Field hockey is one of the most popular team sport in the world and is thought to be the forerunners of all stick and ball games. Injuries in hockey are numerous and can be serious. Despite the sports apparent popularity, the data on injury rates among field hockey players are limited. Most of the research on field hockey was completed over 6 years ago, but the game has undergone significant changes since that time.

Aim: To examine the injuries in field hockey players in relation to playing surfaces.

Material and Methodology: District, state, university, national, international hockey players (N=407) completed the survey questionnaire. They reported personal characteristics (age, height, weight), field hockey information (level, years of experiences, surface), injury history (type, site, cause, severity), and back pain information.

Results: In overall injuries, 64.87% injuries occurred in training on natural grass and 35.13% injuries occurred while training on artificial turf.

Conclusion: There is increase in number of injuries in grass as compared to artificial turf.

Key words: Hockey, playing surfaces, injuries, artificial turf.

Introduction

Some form of ball and club game is as old as man itself. The man has always been fond of playing with round objects and there has always been great fascination in hitting round objects with a stick. Hockey is an ancient game thought to be the forerunners of all ‘stick and ball’ games. The modern game of the hockey is played in 132 countries around the world and is second in popularity to soccer as a team sport. Hockey is an outdoor game played by two opposing teams of 11 players, whose sticks were carved at the spiking end to hit a small, hard ball into their opponent’s goal. It is sometimes called field hockey to distinguish it from the similar game played on ice.

Injuries are a part of sport. There has been gradual change in the pattern of sporting injuries. Some years ago most injuries were acute, traumatic such as fracture, dislocation, ligament sprains and muscle tears. While these injuries are still common, injuries such as tendonitis, stress fracture and compartment syndrome appears to be increasing in frequency. This is undoubtedly due to the increased load placed upon musculoskeltal structure by the increased training demands of modern day sports.

Despite the sport’s apparent popularity, the data on injury rates among field hockey players are limited. The majority of the injuries reported are minor ankle sprains and contusions. More serious injuries such as torn knee ligaments, concussions and eye trauma leading to blindness, have also been noted.1-3

Because these studies tend to focus on elite level athletes, it has been difficult to generalize their results to the field hockey community as a whole. Some authors suggest that increased skill, conditioning and a smooth playing surface decreases the risk of injury2,3,5,6 whereas others indicated that elite players not only have an increased ‘exposure time’ but they may be prepared to take more risks.1,13

Hockey players are exposed to various injuries during running, turning, twisting and stretching activities. It was reported that the majority of injuries in elite players are to the lower limb and to the back.7-9

A major factor in the etiology of lower limb injuries can be the playing surfaces. Playing on harder surface is widely believed to increase the incidence of lower limb overuse injuries.

Material and methodology

Aim of the study was to examine the injuries in field hockey players in relation to playing surface. The sample of the study confined to group of 407 hockey players who belong to district, state, university, national and international levels. They reported personal characteristics (age, height, weight), field hockey information (levels years of experience, surface), injury history (type, site, cause, severity) through a survey questionnaire. Each player signed a consent form before filling out the questionnaire.

Surveyed players had a average age of 18.4 (+7.21) and an average experience of 5.12(+3.75). Of the total surveyed players 74.45% were males and 25.55% were female. Out of 407 surveyed players, there were 21.61% district level, 19.4% state, 48.41% national, 3.19% university, 7.3% international players. All the players reported that they have encountered with atleast one injury during field hockey game or practice.

The present study demonstrated ankle sprain (28.05%) on grass and (26.17%) on turf, shin pain (18.20%) on grass and (13.08%) on turf, hamstring strain (11.99%) on grass and (13.61%) on turf, achillies tendonitis (7.00%) on grass and (5.75%) on turf, knee ligament (7.28%) on grass and (6.28%) on turf, in relation to playing surface in the lower limb. Among these injuries, in the present study we have consider 3 main injuries i.e. ankle sprain, shin pain and hamstring strain as they occurred in greater percentage compared to other injuries.

In the present study upper limb shows contusion (58.53%) on grass and (47.61%) on turf, finger and hand fracture (26.82%) on grass and (38.09%) turf, shoulder injuries (7.34%) on grass and (9.52%) on turf, elbow injuries (7.31%) on grass and (4.78%) on turf in relation to playing surface.

Injuries resulted in head and face are abrasion (73.09%) on grass and (62.5%) on turf, ocular trauma (15.38%) on grass and (37.5%) on turf, dental trauma (7.69%) on grass, concussion ( 3.84%) on grass in relation to playing surface. In the back the present study shows back dysfunction (90.80%) on grass and (84.14%) on turf, acute back pain (8.55%) on grass and (14.28%) turf, Sacroiliac joint pain (0.65%) on grass and (1.58%) on turf in relation to playing surface.

According to the overall injuries reported 64.87% injuries occurred in playing/practicing on with natural grass and 35.13% occurred while playing/practicing on artificial turf. In the lower limb 47.79% injuries were reported from grass as compare to 19.54% in turf, whereas 4.19% of upper limb injuries occurred in grass and 2.14% occurred in turf. In head and neck 2.69% injuries occurred in grass as compare to 1.63% injuries in turf and 15.58% of back injuries were reported in grass as compared to 6.44% injuries in turf.

Graph 1: Common injuries of lower limb in relation to playing surface.

Common injuries of lower limb

Graph 2: Common injuries of upper limb occurring on different playing surfaces

Common injuries of upper limb

Table 1: Distribution of lower limb injuries in relation to playing surface

S.No. Specific injury Playing Surface
Grass Artificial turf
1. Ankle sprain 28.05% 26.17%
2. Shin pain 18.20% 13.08%
3. Hamstring strain 11.99 13.61%
4. Achilles tendonitis 7.00% 5.75%
5. Knee ligament 7.28% 6.28%
6. Quadriceps strain 6.40% 4.71%
7. Groin strain 6.21% 10.47%
8. Patellar tendonitis 6.20% 8.90%
9. Patellofemoral pain syndrome 4.00% 3.14%
10. Gastronemius strain 3.64% 4.71%
11. Foot contusion 1.00% 1.57%
12. Mensci tear 1.00% 1.57%

Table 2: Common injuries of upper limb in occurring on different playing surfaces

Table2

Table 3: Specific injuries of head and face occurring on different playing surfaces

S.No. Specific injuries Grass Turf
1. Abrasions 73.09% 62.5%
2. Occular trauma 15.38% 37.5%
3. Dental trauma 7.69% -
4. Concussion 3.84% -

Table 4: Specific injuries of back occurring on different playing surfaces

S.No. Specific injuries Grass Turf
1. Back dysfunction 90.80% 84.14%
2. Acute back pain (Muscle strain) 8.55% 14.28%
3. Sacroiliac joint pain 0.65% 1.58%

Discussion

The present study shows an increase in the number of injuries in grass compared to artificial turf. In Indian setting, natural grass surface is not fully maintained in terms of quality and texture. The surface is not smooth and ground beneath the grass is irregular further leading to the bouncing effect of the ball which predisposes the players to injury. Also, the grass surface is slippery and less frictional forces are there leading to the instability of the lower limb during activities like running. Increased skill, conditioning and smooth playing surfaces decrease the risk of injury.2,3,5,6 Jamison et al.7 in 1989 reported more injuries in turf (18%) compared to that of grass (12%) which is not consistent with the findings of the present study. This may be due to difference in time spend by a player on both the playing surfaces as compared to that of foreign playing situations. In India a player spends most his time playing on grass due to the decrease in number and availability of the artificial surfaces.

Lower limb is the most frequent site of injury (67.33%) on both the surfaces that were taken into account and ankle sprain was the most common injury reported on grass (28.05%) as compared to synthetic turf (26.17%). The high incidence of this injury can be attributed to the irregularity and ruggedness of the grass surface. Sudden twisting and turning movements which are the requirements of the game along with the interference of stick and ball on the playing surfaces (grass) which is usually uneven, leads to inversion and plantar flexion, resulting in ankle sprains. In addition to this, improper protective devices and foot wear may also cause this injury. In the present study it was observed that incidence of shin pain was higher on grass surface (18.20%). This can be attributed to the improper maintenance of the play grounds, as the surfaces was very hard and irregular. Usually athletes suffer from shin pain because of being overweight, overtraining, tight calf muscles, compartment syndrome and improper playing surfaces. Tight calf muscles, which commonly occur as a result of hard training, will restrict dorsiflexion, increase the tendency for excessive pronation and lead to shin pain. Incidence of hamstring was high on turf (13.61%). Injury to the hamstring muscle can be devastating to the athlete because these injuries heal slowly and have a tendency to recur.4 Synthetic turf produces more resistance to the lower limb while playing than on natural grass. The impact of the surfaces get heightened if there is dysfunction of the hamstring muscles. Inappropriate rehabilitation and repetitive trauma to the muscle may cause a devastating effect on the muscle and reoccurrence of injury.

Upper limb injuries occur due to the contact of stick or ball which comes with greater speed. Finger and hand fracture occur more on the turf (38.09%) as the ball move with higher speed on turf in comparison to grass field. Hence multiplying the impact and leading to fractures and injuries. 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.10 Recent surveys of collegiate and high school field hockey indicate that 14.0% to 15.8% of the total injuries are to the upper limb and most of these are wrist and finger fractures.11,12

In the present study the percentage of head and face injuries (4.32%) on both the surfaces was relatively less but it can be catastrophic is nature compare to the other injuries. The vigorous use of hockey stick for handling the ball increases the potential risk of injury. Abrasions most commonly occur on the grass because the surface is irregular, uneven and when the player falls or dive for stopping, defending and hitting the ball then the injury occurs. Ocular trauma more on turf because of stick and ball contact which comes with high velocity.

In the present study incidence of back dysfunction on grass is very high (90.80%). Sudden twisting movements which result from irregular surface of the grass, conveys unbalancing forces to the spine resulting in pain and dysfunction. The incidence of acute back pain (muscle strain) (14.28) is higher on artificial turf, the back takes the immediate brunt of the impact caused by hard surfaces of the turf resulting in acute back pain, which usually subsides which rest.

Graph 3: Specific injuries of head and face occurring on different playing surfaces

Specific injuries of head and face

Graph 4: Specific injuries of back occurring on different playing surfaces.

Specific injuries of back

Conclusion

Training in natural grass demonstrated more injuries (64.87%) as compare to artificial turf (35.13%). There is difference in playing situation in India and other countries which lead to difference in injury pattern regarding playing surface.

Suggestions

The present study includes general population of male and female players, similar other works may be considered to understand the gender specific injury patterns. Further examination of the injury in relation to playing positions and playing situations that lead to injury should be considered.

References

  1. Bolhuis, JH., Leurs, JM and Flogel, GE: Dental and facial injuries in international field hockey. British Journal of Sports Medicine, 21(4): 174-177 (1987).
  2. Fox, N: Risks in field hockey. In: Sports fitness and sports injuries. T. Reilly (Ed.) Boston: Faber and Faber, pp. 112-117 (1981).
  3. Rose, CP: Injuries in women’s field hockey: a four year study. The Physician and Sports Medicine, 9(3): 97-100 (1981).
  4. James, AC: Hamstring injuries proposed etiological factors, prevention and treatment. Sports Medicine, 2: 21-33 (1985).
  5. Spedding, I: Is there a risk of injury in modern hockey? Sports Coach (Perth, Australia), 10(1): 3-4 (1986).
  6. Moore, S: Field hockey, In: catastrophic injuries in sports. Avoidance strategies. 2nd Ed., Adams, SH., Adrian, MJ., Bayless, MA (Eds.), Indianpolis, In: Benchmark. Pres Inc, 67-77 (1987).
  7. Jamison, S., Lee, C: The incidence of female injuries on grass and synthetic playing surfaces. Australian Journal of Science and Medicine in Sport (Canberra, Australia), 21(2): 15-17 (1989).
  8. Frake, M., Dalgleish, M: Injuries in women’s field hockey. Part one. Sport Health (Canberra, Australia), 12(1): 41-42 (1994a).
  9. Frake, M., Dalgleish, M: Injuries in women’s field hockey. Part two on tour. Sport Health (Canberra, Australia), 12(3): 44-46 (1994b).
  10. Karen, Murtaugh: Injury patterns among female field hockey players. Med. Sci. Sports Exerc, 33(2): 201- 207 (2001).
  11. National Collegiate Athletic Association (N.C.A.A). Injury surveillance system reports: Field Hockey, Overland Park, KS, 199 (1998-99).
  12. Powell, JW., Barber-Fors, KD: Injury patterns in selected high school sports: a review of the 1995- 1997 seasons. J. Athl. Training, 34: 277-284 (1999).
  13. Jones, NP: One year of severe eye injuries in sport. Eye, 2(pt. 5): 484-7 (1988).
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