A computer-based literature search was conducted within electronic databases from 1990 to August 2020 (the lower limit was set in 1990 because of an increase in the scientific literature in that period due to the inclusion of male RH as a demonstration sport in the 1992 Olympic Games).

The consulted databases were PubMed, Web of Science, SportDiscus, Google Scholar, Scielo, and Semantic Scholar, according to the recommendations from the preferred reporting items for systematic and integrative reviews and meta-analysis statement (PRISMA).11

The search terms were: (rink-hockey OR roller hockey OR quad hockey) AND (injury OR injuries OR pathology) that were included in the title, abstract, or keywords of a paper.

To increase research accuracy, two authors (BDM and MCT) separately screened citations and abstracts to identify the publications relevance for inclusion. Only studies focused on injuries of RH were included.

Afterwards, full texts were obtained to ascertain whether the publications satisfied the inclusion criteria. Besides, the reference sections of the selected articles were searched to identify other relevant papers.

Data were collected and stored in a database and checked by both authors in order to find possible discrepancies that were solved by consensus after reviewing the conflictive articles again.

Any research item about rink hockey injuries was included. Articles in English, Spanish, Portuguese, and Italian were accepted. PhD dissertations, final projects for master's and bachelor's degrees were incorporated.

Manuscripts about other team sports with a formal structure similar to RH were not considered (e.g., inline hockey, also referred to in the literature as roller hockey).

Case reports, abstracts, congress posters, and communications in conferences or workshops were excluded.

Fig. 1 uses the PRISMA flowchart to summarize all stages of the process for selecting the papers to review.12

Fig. 1..

Flow chart of the selection of articles to review.

(0.23MB).

The first identification phase revealed 78 research items through database searching and one from another source (directly from the author).

Fifty-four duplicated items were eliminated in the screening phase.

The remaining 25 were then screened for relevance based on their title and full text.

Fourteen items were excluded according to the following criteria: other sports (n = 9), case reports (n = 3), congress posters (n = 2).

Finally, 11 items were included in the review.

We performed a descriptive study of some variables analyzed in the different studies, computing absolute and relative frequencies for categorical variables and central tendency and statistical dispersion measures for continuous variables. All analyzes were performed with the R statistical package (The R Foundation for Statistical Computing), version 3.3.3.

The 11 reviewed items comprised nine cross-sectional or descriptive studies15–18,21–24 and two experts’ opinions.17,18

Following the description of the study design, the evidence level19 was evaluated as III in nine items (81.8%)13,14,16,20–24 and V in two (18.2%).17,18

Nine studies were specific about RH (13–18,21–23), while two studies included RH among other sports or injury evaluation reporting as the primary objective.20,24 Four studies were conducted in Portugal,14,15,21,22 four in Spain,17,20,23,24 one in Italy,18 one in Argentina,13 and one in Germany.16

The primary outcome was described as injury patterns in five of the 11 studies (45.4%);17,18,20,22,23 injury patterns and incidence in two (18.2%) 14,16; injury incidence in one (9.1%);21 and specific incidence of tendinopathy and craniofacial injuries in the last three studies (27,3%).13,15,24

The objective was defined as descriptive in seven of the 11 studies (63.6%),14–16,20,22–24 analytical in two (18.2%),17,18 non-reported in one (9.1%),21 and unclear in one (9.1%).13

All the information in this subsection is summarized in Table 1.

Eight of the 11 studies (72.7%) stated their sample size, ranging from 22 to 289 athletes, with a median of 85.5 (Q1 = 28.2; Q3 = 120.5). All samples were reported as non-randomized.

Five studies (45.4%) prospectively collected injuries through predetermined templates reported by coaches/physical trainers/physiotherapists (n = 4) or by medical staff (n = 1). Three studies (27,2%) used retrospective questionnaires answered by the athletes, two (18,2%) were experts’ opinion, and one (9.1%) was based on a retrospective review of medical records.

Seven of the 11 studies (63.6%) reported the number of injuries, ranging from 13 to 2947, with a median of 81 (Q1 = 61; Q3 = 86.5). Five (45.4%) did not report the injury classification and three (27.3%) used as an injury definition the Junge's formula.25 Finally, three studies (27.3%) focused on specific injuries (two in craniofacial injuries and one in tendon injuries), and only one (9.1%) used a standardized by consensus injury classification (OSIICS).26

Table 1 summarizes all the data reported above.

Seven of the 11 studies (63.6%) reported measures of occurrence, such as: incidence rate (n = 4), proportion (n = 1), and prevalence (n = 2). In two studies, measures were unclear (Table 1).

None used association measures, and only one calculated the confidence intervals.

Two of the 11 studies14,21 presented the injury incidence rate calculated following standardized formulas.25 Both studies were conducted among Portuguese youth players. The total rate was 3.2321–9.714/1000 exposure hours (EH). The match rate was 17.514–36.721(21)/1000 EH, and the training rate was 1.7721–7.514/1000 EH.

Other studies presented injury incidence rates using non-standardized formulas. In Egocheaga's study20 the rate was 7.1 injuries/500 EH, and the formula was not specified.

The Husen study reported 9.4 ± 12.3 injuries/1000 AE (9.8 ± 11.1/1000 AE in men and 8.9 ± 14.3/1000 h AE in women).16 In Husen's study, the AE was defined as the “number of athletes participating in a game or practice regardless of duration or type of exposure”.

In Florit's study,24 the injury incidence proportion of tendinopathy was 64.4 and 19.6 injuries/100 athletes/season, respectively, for professional RH players and youth RH players.

In the specific studies about orofacial injuries, 45/117 (25.4%) of the interviewed players reported at least one orofacial trauma during their career(15) and the incidence rate of craniofacial injuries in Pelaez's study was reported as 85 injuries/100 match hours.13

Although two studies reported an injury incidence rate or proportion during matches and training sessions,16,23 none of them calculated the athletic exposure. The Reverter study23 reported 88 injuries; 26.1% (n = 23) occurred during training sessions and 73.9% (n = 65) during matches. In the Husen study,16 the athletes reported in the injury surveillance questionnaire that 53.3% of their injuries occurred during practice and 46.7% during matches, but these observations were not confirmed or registered by any medical staff.

None of the studies calculated the injury burden. Table 2 summarizes injury incidence.

Two articles with experts’ opinions on RH hockey were found. The first article17 was released during the 1992 Olympic Games. The Medical Staff of the Spanish National Team stated that the most frequent injuries were strains in adductor muscles, overuse injuries in anterior tibial muscles, ankle sprains, and wrist injuries in RH players; and knee articulation injuries (the meniscus tear being the most frequent) and hamstring strains in goalkeepers. The quality score of the study was 19% (Table 1).

The Medical Staff of the Italian National Team18 also released an article in 2014 describing muscle strains in the adductor area and articular injuries in the ankle and knee as the most frequent injuries in RH. Moreover, lower back pain and shoulder tendinopathy were the most frequent overuse injuries. Finally, this study concurred with the Spanish article that the most frequent injury in goalkeepers was the knee articulation injury (meniscus).

Neither studies presented epidemiological data to support these arguments. The quality score of the study was 12,5% (Table 1).

Even though most of the analyzed research is descriptive, design and objective are not reported in five of the 11 studies. According to Nielsen et al.34 failure to be clear about goals may lead to inappropriate, misleading, and flawed conclusions in sports injury research. Therefore, we must encourage that in future research about RH, an optimal study design description must be stated.

Furthermore, none of the included studies presented a high level of evidence, and there were no randomized cohort studies or case-control studies.

The majority of analyzed studies included male professional RH players. Male youth players were also involved in several reports.14,15,21,22,24 On the contrary, female athletes were only incorporated in one study.16 Moreover, the sample size was generally small and comprehended heterogeneous age groups.

The injuries classified by player position were unavailable in epidemiological studies (despite the goalkeepers’ specific injuries mentioned in two experts’ opinion articles). Only three studies used standardized injury definition, and data collection sources were heterogeneous (conducted by athletic therapists, athletic trainers, physicians using injury registry databases). Also, all the included articles except for one did not use injury classification tools such as OSIICS,35 and this may cause a lack of homogeneity in the categorization of injuries. Thus, better consistency and homogenization in the definitions and methodologies may help compare data across studies.26

Finally, more exhaustive studies, including all ages and female athletes, should be performed to obtain better information about RH's actual injury patterns.

Standard measures used to describe the frequency of injury are incidence proportion and incidence rate.36 In a sport-injury context, the numerator is generally the number of injuries or number of injured athletes, while the denominator is often the total number of athletic exposures or hours played during the follow-up period.37

In our systematic review, only two studies used standardized formulas to report injury incidence.14,21 That can be a limitation for further investigations because equivalent formulas allow a comparison between populations and data.

The results obtained in the studies involving Portuguese international youth players showed an overall injury rate between 3.2321–9.714/1000 exposure hours (EH). The match injury incidence ranged from 17.514–36.721/1000 EH and the training incidence from 1.7721 to 7.514/1000 EH. The results can be compared with professional sports, such as ice hockey (15.6/1000 h overall incidence);38 futsal (6.8/1000 h overall incidence, and 44.9/1000 h match incidence);39 handball (6.5/1000 h overall incidence, and 22.2/1000 h match incidence).7 Nevertheless, we should consider that there might be differences between senior players and youth players, so the comparison of the results should be made with caution. In a study conducted on American basketball youth players, the overall incidence was 1.94/1000 EH, and the match incidence was 3.27/1000 EH.7

As shown, results from other sports demonstrated that injury incidence during matches is higher than during training because of several factors (e.g., the higher physical and physiological demands required in matches compared to training sessions.40

Further research must be carried out to confirm this trend in RH with studies on senior players, including female athletes. The final goal will be to implement injury prevention programs.

Despite injury incidence is widely used, injury burden has now been suggested as the most accurate measure to evaluate the impact of injuries in athletes.26 The injury burden should consider the injury and the exposure and time-loss in the equation.41 Nevertheless, none of the evaluated research in our review calculated the injury burden.

Muscle injuries seem to be the most frequent injury in RH players. None of the studies described the affected muscle groups. Joint injuries seem to be frequent in youth players20 Nevertheless, only in one study, the injuries were surveilled by medical staff.20

Lower limbs were the most affected body regions, and moderate injuries (7-28 days) were the most frequent.

Specific studies have been carried out about injuries in the craniofacial area in RH players since these types of injuries have become a reason of relevant concern in all sports in the last decade.42,43 At the moment, no helmet nor mouthguard is mandatory for RH players, although some countries, such as Italy, recommend the use of a helmet in youth players. The Spanish RH Federation (Real Federación Española de Patinage) has presented the project to implement a protective helmet in different categories over the 2021–2022 season.44 This implementation is supported by Lopes22 and Pelaez23 studies concluding that more effective protection gear must be considered for all players to prevent craniofacial injuries. Also, data from other sports support this implementation. Indeed, a helmet is mandatory in ice hockey, where the head is the most reported injured body area.45,46 In inline hockey, the helmet is also mandatory, and the reported head injuries are lower.47

We found two articles about groin pain in RH players.48,49 We excluded them from this systemic review because they did not investigate the epidemiology of RH injuries. Besides, none of them sustained any epidemiological data about groin pain in RH players to justify an investigation about this matter. We think that it is relevant to mention these studies because in a field that is hardly explored, such as RH injuries, the existence of two articles focused on a specific injury reveals a concern.

In addition to the limitations of the included studies, there were also limitations in the review process. The search strategy was deliberately broad to identify all original RH-related studies, including reference searches and knowledge from authors with extensive RH research backgrounds. However, it is still possible that large studies reporting on other sports or injuries could have reported on RH within a subgroup analysis.50

Despite all limitations, our study sets a starting point in the injury surveillance in RH players, willing to understand the physical implications of this sport better.