BACKGROUND
Rink hockey is a fast-paced team sport characterized by repetitive skating, rapid directional changes, and frequent interactions involving sticks, ball, and player contact. These sport-specific demands expose athletes to a wide spectrum of injuries, including both acute traumatic events and overuse syndromes.
In recent years, the epidemiology of injuries in rink hockey has been increasingly investigated, revealing consistent injury patterns across different competitive levels and populations. Previous studies have reported injury incidence rates ranging from approximately 4.5 to 5.9 injuries per 1000 hours of exposure, highlighting the substantial injury burden associated with the sport,. Lower limb injuries are consistently reported as the most common injuries, particularly involving the hip/groin and thigh. This pattern reflects the substantial biomechanical demands imposed by skating, rapid accelerations, and repetitive mechanical loading,,. In addition to lower limb injuries, head and facial injuries represent a significant proportion of traumatic events, often resulting from direct impacts with the stick or ball. Musculotendinous injuries, contusions, and fractures have also been commonly reported, reflecting the multifactorial injury mechanisms present in rink hockey, including both contact and non-contact mechanisms,.
Previous studies have also explored factors associated with injury occurrence. Sex-specific analyses have demonstrated similar overall injury incidence between male and female players, although match exposure has been associated with higher injury risk compared to training. Furthermore, positional differences in injury patterns have been observed in hockey-related sports, with variations in exposure, movement demands, and protective equipment contributing to differences in injury risk.
Comparisons with ice hockey, a related high-intensity sport with greater body contact and more extensive protective equipment, provide additional insight into injury mechanisms and risk factors. Both sports demonstrate a predominance of lower limb injuries and positional variation in injury risk; however, rink hockey appears to present a higher relative frequency of head and facial injuries, likely related to greater exposure to stick and ball impacts and less extensive facial protection,.
Collectively, these findings provide valuable insights into injury patterns and factors associated with injury occurrence in rink hockey. However, limited data are available regarding injury patterns among Portuguese federated rink hockey players. A better understanding of injury patterns and associated factors in this population is essential to inform targeted injury prevention strategies and optimize athlete safety and performance.
Therefore, the aim of this study was to describe injury patterns and identify factors associated with self-reported injuries among Portuguese federated rink hockey players using a cross-sectional survey.
MATERIALS AND METHODS
Study Design and Participants
This cross-sectional observational study investigated self-reported injuries among Portuguese federated male and female senior first-division rink hockey players during the 2024–2025 competitive season. Eligible participants were athletes competing in the Portuguese first division during the study period. Data were collected using a structured anonymous electronic questionnaire distributed to first-division clubs through coaching staff and team representatives between July and September 2025. Incomplete questionnaires were excluded from the analysis. A total of 124 athletes met the inclusion criteria and were included in the study.
This study was conducted in accordance with the principles of the Declaration of Helsinki. Participation was voluntary, and electronic informed consent was obtained before questionnaire completion. The study involved an anonymous questionnaire administered to adult athletes and did not involve patients, clinical records, or experimental procedures. All data were anonymized to ensure confidentiality.
Data Collection
Data were collected using a structured questionnaire that included demographic and sport-specific information such as age, sex, years of federated practice, playing position, dominant hand, and weekly training frequency. The questionnaire was originally developed in Portuguese; an English translation is provided in Appendix 1.
Injury data included the number of injuries sustained, anatomical location, injury type, injury mechanism, severity, and requirement for surgical intervention. Injuries were defined as any physical complaint sustained in training or competition during the 2024-2025 season that resulted in interruption of sport participation for at least one day. Severe injuries were defined as time-loss injuries resulting in more than 28 days of absence from sport participation.
Additional variables included participation in supervised strength training and the availability of physiotherapy support during training or competition.
Injury Classification
Injuries were classified according to anatomical region as head and neck, trunk, upper limb, or lower limb.
Mechanisms of injury were categorized as trauma resulting from stick or ball contact, overload, fall, collision with another player, and other mechanisms.
Injury types were categorized as fracture, muscle injury/contracture, haematoma/contusion, wound/laceration, and tendon injury/inflammation. Less frequent injuries that did not fit these predefined categories were grouped under the category “Other”.
Statistical Analysis
Descriptive statistics were used to summarize demographic characteristics and injury distribution. Continuous variables were expressed as mean ± standard deviation, whereas categorical variables were expressed as frequencies and percentages. Comparative analyses were performed to evaluate differences in the number of reported injuries according to participant characteristics, including sex, playing position, years of federated practice, weekly training frequency, participation in supervised strength training, and physiotherapy availability. Group comparisons were performed using independent-samples t-tests. Statistical significance was set at p < 0.05. Statistical analyses were performed using IBM SPSS Statistics version 24 (IBM Corp., Armonk, NY, USA).
RESULTS
Participant Characteristics
A total of 124 federated rink hockey players participated in the study, including both male and female athletes. Participant demographic and training characteristics, including comparisons by sex, are presented in Table 1. Male players were older, had more years of federated practice, and reported a higher weekly training frequency than female players. Right-hand dominance was most common, although the proportion of left-handed players was higher than the approximately 10% reported in the general population. The distribution of playing positions reflected standard rink hockey team composition, with a predominance of field players compared with goalkeepers (4:1).
Injury Occurrence and Severity
Most athletes reported at least one injury during the season. The mean number of reported injuries per athlete was 3.19 ± 4.06. Overall, 119 (30%) reported injuries were classified as severe, resulting in more than 28 days of time loss, while 25 (6.4%) required surgical intervention. Injury occurrence and severity are presented in Table 2.
Anatomical Distribution of Injuries
Lower limb injuries were the most frequently reported, followed by injuries affecting the head and neck region, while upper limb and trunk injuries were less common (Table 2). Within the head and neck category, facial injuries accounted for 79% of cases and represented the most frequent individual anatomical location overall. Lower limb injuries were distributed across multiple anatomical regions without a single dominant location.
Injury Types and Mechanisms
The distribution of injuries by type and mechanism is presented in Table 2. Fractures and soft tissue injuries were among the most frequently reported injury types, while trauma resulting from stick or ball contact was the predominant injury mechanism.
Factors Associated with the Number of Reported Injuries
Playing position was significantly associated with the number of reported injuries. Goalkeepers sustained approximately 52% fewer injuries than field players (p = 0.00066), with this difference being particularly pronounced for head and neck injuries, for which goalkeepers sustained approximately 83% fewer injuries (Supplementary Table S1).
Most athletes reported participation in supervised strength training (63.4%) and access to physiotherapy during training or competition (57.7%). However, no statistically significant associations were observed between number of reported injuries and either supervised strength training or physiotherapy availability. Similarly, no statistically significant associations were found between number of reported injuries and sex, weekly training frequency, or years of federated practice. Additional analyses exploring injury occurrence across these variables are provided in the Supplementary Material (Supplementary Tables S2-6).
DISCUSSION
This study provides a detailed overview of injury patterns among Portuguese senior first-division rink hockey players and identifies factors associated with injury occurrence that may inform injury prevention strategies.
The principal finding was the predominance of lower limb injuries, which accounted for more than one-third of all injuries. This finding is consistent with previous literature,and may reflect the substantial biomechanical demands associated with skating, including repetitive propulsion, rapid accelerations and decelerations, and repetitive mechanical loading. These demands may contribute to both acute injuries and overuse conditions affecting the lower extremities. The consistency of this finding with previous epidemiological studies supports the relevance of lower limb injuries as an important target for injury prevention in rink hockey, despite differences in study populations and methodologies.
Head and neck injuries, particularly facial injuries, represented the second most common anatomical category and the most frequent individual injury location. The high frequency of facial injuries may be related to repeated exposure to stick and ball impacts,, consistent with trauma being the predominant reported injury mechanism and with previous studies reporting a substantial proportion of head and facial injuries in rink hockey,. Differences in injury definitions, competitive level, and protective equipment between studies may contribute to variations in the reported frequency of these injuries.
Playing position was the only participant characteristic significantly associated with the number of reported injuries, consistent with previous literature highlighting positional differences in exposure, biomechanics, and injury patterns,. Goalkeepers reported substantially fewer injuries overall than field players, particularly in the head and neck region. This difference may reflect lower exposure to high-speed skating and differences in protective equipment between positions. The marked reduction in head and neck injuries among goalkeepers is compatible with a potential protective effect of specialized equipment, although causality cannot be established in the present study.
No significant associations were observed between the number of reported injuries and sex, weekly training frequency, years of federated practice, strength training participation, or physiotherapy availability. These findings should be interpreted cautiously, as the absence of statistically significant associations does not necessarily indicate an absence of effect. Previous studies have also reported differences in injury patterns according to sex and exposure characteristics, although findings have not been consistent across populations,. Differences in study design, sample characteristics, injury definitions, and exposure assessment may partly explain these discrepancies. In the present population, these findings suggest that playing position may be more relevant to injury occurrence than the general training and support characteristics assessed.
Approximately 30% of reported injuries were classified as severe, highlighting the potential clinical impact of injuries in rink hockey athletes. Severe injuries may result in prolonged absence from sport, functional limitations, and increased risk of subsequent injury. This finding reinforces the importance of prevention strategies addressing both the high frequency of lower limb injuries and the potentially greater consequences associated with severe injuries.
From a clinical perspective, these findings highlight several important implications for injury prevention. First, the predominance of lower limb injuries supports consideration of targeted prevention programmes incorporating strength development, neuromuscular control, proprioception, and structured load management. Exercise-based injury prevention programmes have been shown to significantly reduce overall sports injury incidence, with systematic reviews reporting reductions of up to 37% across multiple sports disciplines. Given the high proportion of lower limb injuries observed in this population, structured neuromuscular prevention strategies may be particularly relevant for rink hockey athletes. Second, the high frequency of facial injuries supports consideration of greater use of facial protective equipment, particularly among field players. Evidence from contact sports suggests that protective equipment, particularly full facial protection, may reduce the severity of head injuries in ice hockey. Given the positional differences observed in this study, reinforcement of appropriate protective equipment policies may represent a potentially simple and practical preventive strategy.
This study has several limitations. First, the self-reported design may have introduced recall bias and potentially resulted in underreporting of injuries, particularly minor injuries. In addition, injuries were self-reported and were not independently verified through medical records, which may have introduced misclassification bias. For example, some participants may have classified minor procedures, such as wound suturing, as surgical interventions, potentially leading to an overestimation of surgical treatment in this dataset. Second, the absence of exposure data prevented calculation of injury incidence rates per 1000 hours, which are commonly used in sports injury epidemiology to account for differences in exposure. Third, the cross-sectional design precludes assessment of temporal associations and does not allow causal inference. Nevertheless, the consistency of the main injury distribution findings with previous epidemiological studies supports the relevance of the observed patterns despite these methodological limitations. Future prospective studies should incorporate standardized injury definitions, medical verification of diagnoses, exposure tracking, and position-specific injury surveillance to allow calculation of injury incidence rates and better characterize factors associated with injury occurrence.
Despite these limitations, this study provides novel data on injury patterns among Portuguese federated rink hockey players, a population for which published evidence remains limited. The findings identify clinically relevant targets for injury prevention and may support the development of future sport-specific prevention strategies and prospective injury surveillance studies.
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SUPPLEMENTARY MATERIAL
Appendix 1. Questionnaire used for data collection
This questionnaire was developed by the authors for the purpose of this study and was originally administered in Portuguese.
Credits: Alice Vicente, João Rosa Silva, Joana Alves de Campos, Isabel Crespo, Diogo Rodrigues da Silva, José Maria Moreira
The following questionnaire refers to injuries sustained during the 2024–2025 competitive season.
An injury was defined as any physical complaint sustained during training or competition that resulted in interruption of sport participation for at least one day. Severe injuries were defined as time-loss injuries resulting in more than 28 days of absence from sport participation.