WASHINGTON -- Playing hockey with a bare face can be dangerous to a player's looks.
Researchers studying high-level amateur players discovered that those who did not wear full face protection had almost seven times more injuries than did those who were shielded.
The barefaced players also had more than double the risk faced by players who wore at least plastic visors that extended almost to the upper lip, according to the study in the American Journal of Sports Medicine.
"The real gist of the study is that face masks significantly reduce injury to the neck and face," said Dr. Michael A. Stuart of the Mayo Clinic in Rochester, Minn., who was the principal investigator.
As a result of the study, USA Hockey, the sport's American governing body, has banned barefaced play effective this season, Stuart said. All players must wear full protection, except for players 18 and over, who may opt for visors if they sign a waiver, he said.
In the study, observers monitored 282 elite amateur players ages 16 to 21 in the Junior A division of the United States Hockey League. The observers kept close track of each player's time on the ice. Athletic trainers on the teams kept track of injuries.
Researchers reported their findings as injuries to the face or other part of the head per 1,000 hours played.
The group with no facial protection amassed 159 injuries per 1,000 hours; those with partial protection had 73 injuries per 1,000 hours, and those with full protection had 23. About 70 percent of the injuries were cuts.
The researchers also looked specifically at eye injuries (14) -- the most serious being a detached retina that required several surgeries. Players with visors had almost a five times greater chance of injury than did players with full protection, none of whom had an eye injury. A lack of face protection contributes to "an unacceptable risk" of permanent blindness, the study said.
However, the study should reassure players and coaches that they won't see more concussions or neck injuries because they wear the headgear, said Stuart, who is USA Hockey's chief medical officer. Those who protected their faces had no higher risks than those who did not, he said.
Some coaches have felt that players who wear protection might take chances which could get them hurt, Stuart said. And some players feared the equipment would make them look timid, encouraging other players to be more aggressive against them, he said.
Those opinions had never been tested scientifically -- and when they were, in this study, no greater risk appeared, Stuart said. Just the same, the idea can't yet be ruled out, he said.
One limitation in the study is that the players could not be assigned randomly to wear full, partial or no protection. As a result, it is possible that there is some other explanation for the differences in injury risks. For instance, players who wanted more protection might have had more concerns for their safety and stayed out of dangerous situations.
For ethical reasons, researchers could not assign players to go without safety equipment, Stuart said. But the fairly even distribution, and the elite level of play in each group, indicate the players actually were similar, he said.
Players would be "foolish" not to wear facial protection, said Mark Tabrum, director of coaching education for USA Hockey, who was not part of the study team. Younger players have been raised on playing with their faces covered, so they shouldn't mind, he said.
However, some players may play barefaced anyway, said Tabrum, who conceded that he's one of them. "It's a habit at this point," although a bad one, he said.
The researchers also looked at the value of mouthguards. Fourteen percent of the total 113 injuries were to the mouth and teeth, and 57 percent of the time in which players were not wearing head protection, they also had no mouthguards, the study found. "Lack of proper mouth protection may have significant medical and economic benefits," the study said.
A separate study, done by researchers at the University of North Carolina, Chapel Hill, looked at the benefits of mouthguards in 50 NCAA Division I basketball teams. The study, also published in January, is in the journal Medicine and Science in Sports and Exercise.
It concludes that custom-fitted mouthguards, which can be made by trainers at a cost of $20 or less, can prevent a lot of costly dental work. But the study found no reduced risk of concussion.
The apparent lack of benefit against concussion may be because a mouthguard can only reduce the impact if the blow to the head comes from under the chin, but basketball players can be hit from many directions, said Cynthia R. LaBella, the lead researcher.
On the Net:
American Journal of Sports Medicine article: http://journal.ajsm.org/cgi/content/full/30/1/39
Medicine and Science in Sports and Exercise abstract: http://www.ncbi.nlm.nih.gov/PubMed; search for LaBella.
USA Hockey: http://www.usahockey.com/index.jsp
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