The Right Call

New Focus Looks To Keep Officials Safe From Injury On The Ice


It is often said that no one notices the referee until he or she makes a bad call.

There is a great deal of attention paid to the management of orthopedic injuries and other medical issues for ice hockey players, starting at the youth level and continuing into the collegiate and professional levels. 

While the research and treatment options for players continue to evolve, what is being done to care for the referees and other officials that patrol the ice? These men and women accept significant risk to enforce the rules and ensure safe play for all participants on the ice, and it is time for us to do better by them as they keep the athletes safe playing the game that we love.

Most fans don’t even notice the referees and linesmen during the game. That is, until they make a call against their team. While they are not commonly thought of as such, it is important to recognize that ice hockey officials are accomplished athletes. These zebras have a job that is physically and psychologically demanding. They never get a break on the ice, as there are no line changes for them. In fact, it is not uncommon for referees to skate up to 10 miles during a hockey game.

Hockey officials on the ice are at high risk for injury given their lack of protective equipment and frequent contact with players, razor-sharp skate blades, flying pucks, composite sticks and unforgiving boards. The sports medicine community has not dedicated any significant time or research effort into understanding the injury patterns sustained by these officials.

That is until now. A recent study published in the Orthopedic Journal of Sports Medicine looked to understand injury patterns in ice hockey officials covering the International Ice Hockey Federation competition. 

A 61-question survey was created and distributed at the IIHF Annual Winter Meeting in 2020 to evaluate musculoskeletal injury patterns experienced by ice hockey officials during competition and training. 

There were 264 officials from 45 countries that completed the survey. Participants were 72 percent male and 28 percent female, had an average age of 31, with an average of 11 years of officiating experience. 

The responses revealed that 55 percent of the officials in the study reporting a job-related injury. About 90 percent of the injuries reported were traumatic, and only 10 percent resulted from overuse/overtraining. Each injury, on average, caused the officials to miss approximately three weeks of work. 

There were some surprising results from the study, and notably, the injury types and patterns identified were not consistent with any previous studies done on referees in other sports.  

Wrist and hand injuries were the most frequently reported, followed by concussions and then knee injuries. While knee injuries were not the most common, they were the type of injury most likely to require surgery, with 64 percent requiring an operation. These injury patterns contrast with prior studies looking at soccer and Gaelic football officials, which identified hamstring strains, calf strains and ankle sprains as the most common injuries.

One of the most encouraging findings of this study was that well over half of the IIHF officials were engaging in injury prevention activities such as yoga, physical therapy, massage therapy or utilization of a personal trainer. These injury prevention activities, in combination with time away from the rink, may be helpful in reducing the injury risk in hockey officials. The study suggested that referees who work year-round were much more likely to sustain an injury than those who did not, further strengthening the argument that taking a break is beneficial. The dangers of overtraining/overworking are well-documented in the literature.

We propose that the medical community dedicate the same attention to ice hockey officials as it does to the players with whom they share the ice. Increased knowledge of these injury patterns will allow the medical personnel who cover hockey games to provide the best possible care. 

The IIHF now includes officials in their Injury Reporting System. This improved attention to the medical care of officials will also promote and guide future research on injury prevention for these officials. 

Finally, the high number of hand and wrist injuries in these officials suggests they could benefit from wearing protective Kevlar gloves, and this measure deserves further consideration and discussion by the hockey community. 


Charles A. Popkin, MD is an associate professor of Orthopedic Surgery at Columbia University/New York Presbyterian Hospital in New York City. He is a member of the USA Hockey Safety and Equipment Committee.


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