36 - The Cost of Back Injuries in National Hockey League Athletes

Background
Hockey is a high-velocity sport with unique forces on the back and spine, and elite players are at elevated risk for injuries. Hockey has been shown to have the highest incidence of cervical and lumbar spine injuries. Despite the documented prevalence, the economic loss following back and spine injuries in National Hockey League (NHL) players has not been evaluated. The purpose of our study was to report on the incidence of back injuries sustained by players as well as quantify the financial impact of these injuries on NHL teams. We hypothesize that NHL teams incur significant losses annually as a result of salaries paid to injured players.

Methods
Publicly available injury databases were used to identify NHL players between 2008 and 2019 that had reported back or spine injuries and subsequently missed regular season games. Statistics including the number of games missed per season due to injury and annual salary were retrieved from the database and used to calculate an estimated value for the total number of games missed by the player during the regular season. Additionally, a comprehensive online search was utilized to characterize each player’s back injury further for symptoms, diagnosis, and whether the player underwent surgery when available as well as return to play status and level of return. Descriptive statistics were reported for all study variables.

Results
A total of 194 unique NHL players were reported to have a back and or spine injury between 2008 and 2019 (Table 1). Athletes who injure their back or spine miss on average 20% of the season due to their injury, with the most recent season (2018-2019) showed an average of 30% of the season missed due to injury. A total of 43 players (22%) underwent surgical intervention, of which only 80% of players returned to play. A total of 30 players (15%) did not return to the same level of play after their injuries, of which 15 players (50%) had a career-ending injury after which they subsequently retired. The value of total number of missed games per season for all players was on average $1.5 million, and has increased over time. This is in contrast to the total number of injured players per season which has steadily decreased over time (Figure 1). The average cost per injured player per year was found to be $781,800, however there was a trend of increasing cost over time. The total value of all missed games by players due to back and spine injuries from 2008 to 2019 was $167 million (Figure 2).

Conclusions
Back and spine injuries have a substantial economic impact on NHL players and the league, with a total of $167 million lost on injured players from 2008 to 2019. Players with these injuries miss a greater number of games than other common injuries experienced in the NHL.