Making Sense of Pain in Boys’ Competitive Minor Ice Hockey

in Boyhood Studies

ABSTRACT

The study on which this article is built identifies psychosocial factors that come into play when boys experience pain and, more specifically, how these particular boys attribute meaning to such experience. Twelve male competitive ice hockey players aged nine to thirteen years participated in small focus-group sessions. Pain from exertion/fatigue, acute pain, chronic pain, and pain from a head injury were examined. The older boys had a more advanced understanding of pain but all the boys engaged in sense-making strategies to play through pain. They were all well informed about concussions and many exercised a greater level of caution towards symptoms of a head injury compared to chronic pain or discomfort from exertion. Educating young athletes and adults about the implications of pain and injury both in and beyond the sport itself may help deconstruct the false sense of invulnerability associated with being a competitive athlete.

Pain is a natural mechanism of defense against trauma that can lead to the breaking down of the structure of the body (Howe 2001; Tesarz et al. 2012). However, pain’s important signaling and diagnostic features are often overridden by the desire of athletes to conform to what they think of as the sport ethic (Hughes and Coakley 1991; Malcom 2006; Nixon 1993), the mentality that an athlete accepts risks and plays through pain in order to achieve sporting goals. This idea of what it means to be a real athlete has long been prevalent in professional sports and has made its way into youth sporting cultures. Children as young as eight use phrases such as “toughing it out” when speaking about their experiences with pain and injury in sport (Nemeth et al. 2005). Singer (2004) observed that some young athletes even considered pain and injury ideal outcomes of playing sports. In contrast, Hughes and Coakley (1991) observed that children entertaining themselves recreationally and at their own pace simply did not play sports until it hurt.

Studying pain response is complex because reactions that follow painful stimuli can be unintentional responses such as facial expressions or vocal exclamations, but some can be controlled and managed to hide pain (Craig et al. 2010). Researchers studying the mechanisms of active pain modulation found that the presence and experience of pain is often poorly related to the nature and magnitude of tissue stress or damage (Chou et al. 2009). Nancy Malcom (2006) suggested that the most effective and insightful way to observe and understand the internal processes that occur when athletes feel pain and injury in sport is to discuss these experiences with them directly. Most studies (Pike 2004; Theberge 2008; Young et al. 1994) on pain and injury have used retrospective studies with experienced, senior-level athletes, likely because adults are usually considered to be more capable of describing and talking about internal and subjective experiences like pain. However, we now know that children are not only capable, but are willing to share their thoughts and feelings when prompted about everyday pain and pain related to illness (Kortesluoma and Nikkonen 2004).

Children learn about and make sense of pain as they mature cognitively and experience such stimuli in various situations (Harris 1993). For young athletes, this mental process seems to be accelerated because they experience pain and damage to the body more often in sport than in most other situations (Nemeth et al. 2005). Sport-related pain experiences also involve a set of social processes that have an impact on the resulting pain behaviors and the individual’s identity as an athlete (Malcom 2006). These social processes incorporate expected social behaviors (displays of physical and mental toughness) and external influences (coaches, parents, peers) that children take into consideration when they feel pain. For example, Rhonda Singer (2004) observed that a recreational basketball team established and used a hierarchy of injuries to dictate whether or not a player was to “act hurt” or simply “shake it off.” Moreover, sport pain behaviors are unique since they are often normalized and even celebrated as representations of true determination and dedication (Curry 1993; Malcom 2006; Pike 2004; Theberge 2008). Finally, the process of enduring pain, as Lindsay Fenton and Robert Pitter (2010) argue, is not only one of socialization but of physiological changes to the body. Fenton and Pitter’s observations of male high school and university rugby teams support the existing evidence that athletes are able to train their bodies to tolerate increasingly higher levels of pain and/or discomfort (see also Jaremko et al. 1981; Ryan and Kovacic 1966; Tajet-Foxel and Rose 1995). Dealing with pain as an athlete becomes more than just an instinctual response and must be considered as a multifaceted learned process—mental, social, and physiological—and “not simply what athletes do” (Malcom 2006: 496; see Fenton and Pitter 2010).

Michael Messner and Michela Musto call for research that takes a critical approach to the taken-for-granted assumption in our society that youth sport is a term that can be interchanged with athlete development. They hypothesize that “the potential health (and other developmental) benefits of playing sports may actually be lost or worse [sic] when kids pour too much into sport identities, practices and goals” (2014: 115). Harm to young athletes can occur when they come to believe that they must endure pain to succeed or attempt to imitate the commonly alluded to no pain, no gain mentality in elite sport (Nemeth et al. 2005). When coaches, parents, and mentors exert pressure on athletes to keep playing by providing pain killers and temporary remedies (Curry and Strauss 1994; Nixon 1992; Roderick et al. 2000; Safai 2003), imposing sanctions on athletes who succumb to injury, and glorify those who do not (Nixon 1992; Roderick et al. 2000), the outcome can be long-term chronic disability. The recent trend of early, single-sport specialization, entailing year-round training and intense practice schedules, is contributing to a sharp increase in the prevalence of overuse injuries among young athletes: orthopedic surgeons are performing surgeries to repair these chronic sport injuries on children and young adolescents, a phenomenon they attribute to excessive training regimes and inadequate rest periods (Bach and Shilling 2008). This trend signals the need for further analysis into how overuse injuries first occur, how they evolve and progress into more serious and chronic injuries, and how best they can be prevented.

The purpose of our study was to examine the meaning young male ice hockey players attribute to signs and symptoms of acute and chronic pain and how they react to and describe these experiences. We chose to focus on boys only because related studies to date, including Nemeth et al. (2005) and Malcom (2006), used samples of primarily young female athletes. Ice hockey holds a long-standing and important place in many Canadian households, and many children are exposed to its culture of violence and emphasis on toughness while they are learning to play the game. It is also a sport that promotes early sport specialization, which increases the risk of overuse injuries and symptoms of mental and physical fatigue. Studies have found that ice-hockey-related injuries may account for more than 10 percent of all youth sport injuries (Emery et al. 2006; Kelly et al. 2001) in Canada. Studies have also shown that the rate of injury in minor ice hockey increases with each age level (Darling et al. 2011; Emery and Meeuwisse 2006; Stuart et al. 1995) and is six times greater for competitive players than those participating in recreational leagues (Willer et al. 2005). Concussions occur frequently in ice hockey and can have lasting and devastating physical and neurological effects (Laurer et al. 2001). Michael Cusimano et al. interviewed minor ice hockey players, as well as coaches and support staff, and found that underreporting of concussions was related specifically to factors such as the player’s motivation to win, the player’s failure to recognize concussion symptoms, and an under-appreciation of the health risks posed. They found masculinity in various forms of control and domination of the hockey game and/or opponent players was often associated with this underreporting of concussions: only players who scored or fought the opposition could be “heroes” (2016: 3), not players who were sitting out because of concussion symptoms or injuries.

Malcom (2006) and Anne Stafford et al. (2013) advocated for more research on pain gathered early on in an athlete’s career. In response, this study examines the meaning male minor ice hockey players attribute to signs and symptoms of acute and chronic pain and how they react to and describe these experiences.

Methods

Twelve boys between the ages of nine and thirteen (mean age = 11.1 ±1.38) participated in four separate focus groups that ranged from two to four participants. We facilitated focus group interviews with the intent of creating a comfortable environment for the participants since they were or had previously been teammates. We also wanted to observe the natural exchanges and discussions that occurred throughout. The group discussions could have had some limitations: participants may not have felt comfortable sharing these experiences among teammates or may have recounted or altered their responses to appear stoical or tough.

We used convenience sampling to recruit players from two ice hockey leagues, one in Wolfville, Nova Scotia, and one in Ottawa, Ontario. In both provinces, body checking is illegal until competitive players reach age thirteen.

We designed a semi-structured interview guide for all four focus group interviews of thirty to forty-five minutes each. We asked participants to elaborate on their pain experiences and share their views and attitudes about pain in ice hockey. According to Sharron Docherty and Margarete Sandelowski (1999), children often use scripts to anticipate, comprehend, and re-create life experiences, and therefore they propose using questions that resemble “what-happens-when” scenarios. Using realistic, yet fictional scenarios also helped us address the topic of pain and injury without relying on, or probing the participants to share, their personal experiences. Our interview guide contained four scenarios about boys as well as follow-up questions.

Scenario 1:

worsening pain in a knee throughout a hockey game without any indication of acute trauma or other explanation (fatigue/exertion pain)

Scenario 2:

symptoms consistent with a head injury

Scenario 3:

pain in a wrist felt immediately after a fall (acute pain)

Scenario 4:

hip pain that occurred throughout the season but had not been diagnosed (chronic pain)

During the focus group discussion, participants drew on some of their non-hockey sport experiences without being prompted. We considered these experiences to be part of their narrative and included them in our content analysis. We used an inductive thematic analysis approach, also referred to as conventional content analysis, to analyze the data.

Results and Discussion

The results of the research reflected the widespread notion that enduring and coping with pain and injury is a requirement for sport participation (Young 2012). The boys described reactions to pain that embodied this mentality such as “shaking it off,” “playing and pushing through it,” and “taking a rest, and trying again.” Thus, the idea that pain and injury “simply comes with the territory” (Young 2012: 106) was a consistent theme throughout our discussions with the players, who recalled at least one, but often many, situations in which they had felt pain while playing hockey. Martin Roderick et al. (2000) explained that the normalization of pain depends on two things: externally imposed institutional settings and self-imposed values that athletes learn to accept early on, the latter of which was the phenomenon examined in this study.

Age, Experience, and Social Learning

A variation in the players’ age and skill level allowed for a comparison between and among their reactions and responses to the different pain scenarios addressed during each of the interviews. Similar to the findings of Rosa Esteve and V. Marquina-Aponte (2011), children’s and adolescents’ pain perspectives progressed and became increasingly complex with age. For example, our data indicated that the nine to twelve year olds attributed the cause of knee pain in Scenario 1 to external factors such as “banging it on the boards” or “getting a puck in the knee” while older players (thirteen years of age) used medical terms like “cartilage,” “hyperextending” something, “bruising the back” or a “slight muscle tear.” Nemeth et al. (2005) explained that developmental differences in an athlete’s knowledge of sport-related pain is also a product of his or her level of exposure to different pain sensations, a spectrum that is assumed to grow throughout one’s athletic career. The finding that older boys more often described pain using anatomical references and medical terminology indicates that educating them about pain from these perspectives may be appropriate and useful for when they must assess and share their own pain symptoms with others (such as coaches and medical practitioners).

We specifically questioned the players on how they had acquired their knowledge of sport-related pain. For example, when we asked how they knew that muscle fatigue indicated they were “getting stronger” and that the feeling of lactic acid was “good pain,” they expressed similar answers: “Probably just know that from playing over the years” (Dylan, ten), “Just something we know” (Will, ten), “It’s just from experience” (Alex), and “Just like working out with the team and stuff” (Noah). The idea that an athlete learns to manage pain in different circumstances “just by playing” suggests that these norms go unquestioned throughout an athlete’s early career especially for pain that comes as a result of exertion or fatigue. Recognizing and coping with chronic pain, however, seemed more problematic for the players.

Discussing the chronic pain scenario in which there is no obvious reason for the pain described, the players admitted they were less certain about the cause of the hip pain and how to manage it. The narrative Nathan (nine years of age) provided identifies a cause but is also vague and metaphorical.

Someone body-checked him in the hip and then it went close to the ice and then he was like ‘I can shake this off’ and then it got worse and worse and worse. Now he’s in the middle of the season like stranded on an island and nothing, doesn’t know anything about it.

Some players resolved this by normalizing chronic pain and finding a way to accept it or cope with it as described in the dialogue below.

Brandon:

So, like you need to do something about it. You have try new things. Like it’s trial and error, kind of. Like if it’s been going on for a long enough time, it’s probably not something that you can do, like I can’t change the arch in my foot. It’s just no effect.

Noah:

I’ve had this injury reoccur a lot so like I kind of know how to deal with it after practices and stuff now, and what precautions to take.

Alex:

I’d take what they [physiotherapists] say, like if they say “[resume] activity as how you feel,” I’d probably just play through it. But if they say, … “there’s a big chance that you can tear something and it can get even worse,” I wouldn’t play. But if it’s like just going to keep hurting, then you can [play].

These examples demonstrate that young male athletes may be aware early on that conditioning pain is useful and that it leads to a positive outcome but have less knowledge about pain that is of a more undefined origin. Characterizing chronic pain as inevitable, permanent, and untreatable is a harmful mindset that is a contributing factor to many of the overuse injuries observed in youth sport (Bach and Shilling 2008). Furthermore, some athletes use this pain to reaffirm their identities as athletes and show commitment to the sport and to their aspirations by playing with pain (Hughes and Coakley 1991).

When players are required to cope with discomfort and pain, it becomes a chance for them to demonstrate their commitment and level of dedication to the sport (Hughes and Coakley 1991; Pike 2004). The following exchange discusses the case of a player blocking a shot and the process of what goes on afterwards as he returns to the bench.

Alex:

For me, everyone knew I was in pain. After I blocked the shot, I went straight to the bench.

Interviewer:

And told the coach?

Alex:

Well, everyone knows that you’re injured after you block a shot.

Interviewer:

Does it happen a lot?

Noah:

If you play on the penalty kill and shots are coming from the point then.

Alex:

Yeah.

Noah:

It’s hard to get out of the way sometimes. You do it for the team.

Alex went on to describe the “injury” as being “a stinger for the rest of the game” but to him this pain made sense because it was a sacrifice for the team and there was nothing to be done about it until after the game. The routine nature of the incident may also trivialize the extent to which the players were justified in “acting hurt” (that is, they could make their way to the bench but were expected to return to the game). For example, some players are considered “shot-blocking specialists,” praised by coaches and glorified by the media (Cosh 2013). Likewise, hockey’s emphasis on speed, skill, and physical toughness helps contextualize and promote pain as a by-product of training and competition (see Sabo 2004).

Making Sense of Pain

Kevin Young et al. (1994) identified four main sense-making strategies (hidden, disrespected, depersonalizing, and unwelcomed pain) that athletes use to justify playing through pain and returning to play even when this requires them to risk further injury. To date there is no known research done on examining the presence or use of these strategies in a sample of young competitive athletes. However, in our analysis of the boys’ perceptions of pain, we found evidence of all four of these strategies.

First, hidden pain involves going out of one’s way to ignore pain. This strategy was alluded to when athletes repeatedly referred to “shaking it off” or “pushing through it.” Brandon provided a clear example of hiding pain from others around him and ignoring it psychologically when he responded to the question of whether coaches or teammates could see if a player was in pain after receiving a hit to the head.

No, no, because sometimes you can’t tell if someone’s in pain with their brain. Like people can’t tell if I’m ever [in pain], like I’ll get my head hit and the coaches will ask if I’m okay, and like I have little tiny bit of pain in my head but I’ll always like just bite on my mouth guard and it always will go away no matter what. Like whenever I bite on the mouth guard, it will go away for some reason.

Thirteen-year-old Alex shared a personal experience during which he had to make sense of an injury during a lacrosse game.

I took a slash right on my thumb and I felt the pain and then when I got on the bench I was icing it as soon as I got on the bench and then I just turned around and I tried to put on my glove. My hand was so swollen I couldn’t put on my glove. … I guess like the pain if you break it, even the pain threshold for that can be pretty high. Say like I was ready to play through it—I just couldn’t put on my glove. So I was like yeah this is definitely broken.

In this example Alex implied that pain, which falls within a certain physical boundary (defined in this case as being able to put his glove on) and does not cross the psychological pain threshold (the intensity of pain one can withstand), can be hidden from others and ignored by the self. This idea describes what Fenton and Pitter call a player’s “return to play continuum,” (2010: 215) which is determined by sociocultural, psychological, and biophysical factors. For Alex, the continuum along which his decision to return to the game after getting “slashed” was bound only by the physical limitation of not being able to put his glove back on.

Second, disrespected pain is a strategy that engages the athlete in a process of distinguishing certain kinds of pain from others and adopting an attitude of irreverence towards some types of pain (Young et al. 1994). The boys in our study definitely distinguished head injury pain from other kinds of pain as illustrated by Alex and Noah.

Interviewer:

What if this player got hit [in the head] during a playoff game?

Noah:

I still wouldn’t play

Alex:

Nope.

Noah:

It’s just not worth it.

Alex:

Anything other than the head, I’d play, but the head, no.

Some of the boys, including Alex and Noah, went beyond irreverence to welcoming and accepting conditioning pain.

Alex:

Your legs and lactic acid—for me that’s not pain. Like, say, if you’re running up stairs, you get lactic acid. So in a hockey game, with all the atmosphere, you don’t even feel it.

Noah:

Yeah, you just kind of play through it, just the adrenaline.

Alex:

It’s not even pain ’cause it goes away.

Third, the strategy of depersonalizing pain has the goal of allowing the athlete to maintain a sense of invulnerability and detachment from the pain by using vocabulary that separates the self from the body. Interestingly, Alex (thirteen), Noah (thirteen), and Brandon (twelve) discussed head injuries in a way that both objectified the rest of the body and also implied that concussions could blur the distinction between mind and body.

Alex:

Say if I hurt my hand or something, I would rather break my arm than have a concussion. Just one concussion, I’d rather yeah. ’Cause like it doesn’t affect you [just] in hockey—it affects your life.

Noah:

Long term it’s just, it’s going to affect you a lot.

Brandon:

Yeah, when I had my concussion my mom talked to me a lot about it and my mom knows a girl and her son played hockey and he had so many concussions that he doesn’t even think right anymore.

Last, athletes using the unwelcomed pain strategy understand that their pain may be poorly received by teammates and coaches and reacting to it may lead to negative consequences. This was a strategy brought up only by the older higher-level players. Alex stated that “with your coaches you don’t really want to like show weakness I guess. Like say, if I have like a bad cough, when you’re by the coaches, like I won’t cough” and Noah responded, “’cause they might affect your ice time.” These sense-making strategies give individual meaning to pain sensations that then, as Sabo described, “become grafted to identities, habitualized by physiology” (2004: 75). In other words, the self-knowledge that the athletes demonstrate is in some ways a shallow perception bounded by an instrumental view of the body that prioritizes, ignores, and/or negatively receives pain in a way that makes sense to the athlete.

Being Injured Versus Being Hurt

The process that seemed to be the most important to the boys was determining whether or not pain was bad enough to qualify as an actual injury. In Sabo’s terms, the question ultimately becomes “are you injured or are you hurt?” (2004: 68). According to former National Hockey League star Gordie Howe, “it is critical to be able to distinguish between being hurt and being injured. Hurt you can play through, but if you are injured you’d better sit down or risk making it worse” (2015: 186).

Noah described this as knowing your limits, and some players provided examples of negotiating and defining what these limits were and what types of pain fell into and outside of these boundaries. Nathan associated being “really hurt” with having a concussion or being unconscious.

Nathan:

If you scratched your knee on something or if it’s like not that much pain, you say… ‘I’m not that hurt.’

Jordan:

Unless you’re injured, that’s the only time it would hurt the next day.

Patrick (eleven) described “getting used to” pain: “When I injured my arm and it hurt, I did this [moved arm]. I just kept on doing it, and I just got used to the pain, and I could just go play.” Alex implied this when he talked about a situation of pain over the course of several games: “You feel it, and if you keep using it and the pain doesn’t change—It’s always going to hurt. So, that’s why you play through it.” The pain then becomes not only hidden from others, but also normalized by the player himself who continues to play through it.

During our observations, it became clear that certain types of pain and injury were considered more serious than others. The boys’ vocabulary of pain reflected a hierarchy of injuries that dictated and justified their responses. Rhonda Singer describes this as the standards players use “to distinguish between injuries that were serious enough to ‘act hurt’ and those that were no big deal” (2004: 225). For our participants, head injuries were at the top of this hierarchy. The unanimous reaction to the head-injury scenario was to “stop playing” or at the very least “take a rest.” As noted earlier, Alex and Noah exemplified this attitude when they said they would not play with a head injury even during a playoff game.

Alex:

If I had too many concussions and I couldn’t play hockey, like if it wasn’t safe for me to play, I wouldn’t play.

Many of the boys also stressed the slow and gradual recovery required following a concussion (McCrory et al. 2013). The lower level players, Aiden, Brandon, and Michael, all spoke with a cautionary tone about some of their own recovery experiences following a head injury. For example, Aiden stated, “What I did when I had mine—I started going for little jogs and working up to that expectation of doing a full practice.” Finally, another common mindset was that “coming back too early” posed a risk to the player’s well-being. The concussion history of Sidney Crosby, who is widely considered to be one of the best ice hockey players in the world, came up in two of the interviews indicating that players who understand these injuries are also taken seriously at the elite level. A conversation between Noah and Alex illustrates the impact modeled behavior has on attitudes at the younger level.

Alex:

Like, I respect Sidney Crosby because he knew when he was in pain.

Noah:

He tried to fight through it for about two, three games but then he was, like, ‘No, I can’t do it.’

Alex:

And yeah, he was off hockey for a long, long time.

Noah:

Like, he’s a legend. He’s teaching the kids not to go back out there and fight through it. He’s, like, ‘know your limits.’

All participants, regardless of age and caliber, used very similar vocabulary and explanations to describe the cause and nature of concussions. They attributed head injuries to the “brain shaking,” the brain “getting bruised,” or the player coming back “too soon” after head trauma. As illustrated earlier by Alex, Noah, and Brandon the majority of participants implied, if not stated, that concussions could have detrimental long-term impacts and identified symptoms such as headaches, dilated pupils, and delayed peripheral vision without being prompted.

Although a number of participants mentioned a history of head trauma, this factor did not seem to lead to a greater level of knowledge on the nature and effects of concussions than in the participants who reported not having suffered head injuries. This replicated the results found by Meganne Gourley et al. (2010) who did not find previous concussion diagnoses to be significantly related to the number of concussion symptoms athletes aged ten to fourteen were able to identify.

A recent study by Cusimano et al. (2016) found that the minor ice hockey players they interviewed had difficulty recognizing concussion symptoms and understanding the potential consequences. The participants in our study were eager to discuss the topic of head injuries and appeared well informed on the subject. However, education may not be enough. Brandon’s example (see hidden pain above) supports this argument and is a reminder that pain while being actively engaged in the sport (or “on the ice”) becomes a multidimensional experience that affects how it is processed and dealt with. Even though Brandon knew the effects of head trauma when his head was hit, he bit on his mouth guard to make the pain go away.

Displays of courage and strength of character are valued within the sport of professional ice hockey and portrayed in the media as inherent to the game itself through masculine discourse, media representations such as “hit parades,” and media analyses that prioritize elements like penalty minutes, fights, shots blocked, and hits (Young 2012). These aspects also serve as examples of the positive reward systems that enforce this type of so-called gritty play and not only justify but encourage behaviors that would otherwise be irrational and forbidden in everyday life (Young 2012). Because of such ingrained norms, many expect players to stoically risk their health and safety for The Game (Sabo 2004). It is a surprise and inspirational when players such as Sidney Crosby recognize their limits and appropriately tend to their injuries.

Conclusions

The normalization of violence, pain, and injury occurs within a cultural context of risk and an institutional network of social relationships that instill a realization in athletes that pain is “just a part of the game” (Messner 2003: 50; see also Hughes and Coakley 1991; Nixon 1992). This potentially harmful commitment to the athletic identity occurs through a learning process that starts early on in an athlete’s career because of the way that youth sport continues to be based on adult sporting values and norms. Adequate supervision, safe and functional equipment, as well as appropriate rules and regulations are ways in which children are protected from physical and emotional harm while they take part in various sports. However, our research suggests that caring for children’s well-being also needs to involve monitoring and assessing their knowledge of sport-related pain and their attitudes and tendencies to ignore painful sensations and/or conceal them from teammates and coaches. This idea is further reinforced since pain literature and the analysis of boys’ responses in this study show that young athletes may not grasp the full implications of pain sensations because of their developmental stage (Esteve and Marquina-Aponte 2011; Gaffney and Dunne 1986; Harbeck and Peterson 1992).

As pain understanding becomes more advanced with experience and cognitive development, the standards around these sensations and what it means to be hurt or even injured become narrower. This means that although boys may have a better understanding of pain in its physiological sense, they have internalized responses to pain that reflect cultural masculine ideals of toughness, aggressiveness, and strength. In the sporting world, these characteristics translate to respected acts of commitment and dedication to The Game. In this way, the “socialization to masculinity and to the sport ethic tends to occur simultaneously and to be mutually reinforcing for boys” (Malcom 2006: 500), thus promoting the normalization of such attitudes and behaviors at a young age.

This phenomenon has also been observed in young female athletes suggesting that socialization into sport may be more important than gender in explaining why athletes accept and compete with pain and through injury (Young 2012). Female athletes use similar rationales and normalizing strategies as boys and men when they subject themselves to pain and injury to maintain their athletic identities and avoid negative sanctions (Malcom 2006; Young and White 1995). It also seems as though young athletes participating in team sport cope with and react to pain similarly to those in individual sports environments. In their study of young gymnasts, Nemeth et al. (2005) found very few of those athletes considered external pressure to be the reason why they continued gymnastics through pain, which is consistent with our findings. This suggests that at this age, athletes’ motivations to play through pain are occurring internally as they make sense of these sensations and consider the outcomes based on their own understandings of pain and the social context around them (Nemeth et al. 2005). Making sure that children react to pain in a way that does not harm their health and safety or put them at risk is a shared responsibility between and among the athletes, parents, coaches, and youth sport organizers.

The boys in this study did not seem apprehensive about discussing their experiences with pain and injuries while playing sport. Many of the athletes directly stated that the first adults they approached and talked to about their pain were their parents. However, this discussion usually occurs on the way home from the game or practice, which may be too late since certain injuries require immediate attention. Coaches and training staff must take on the responsibility of being first responders, which involves assessing, monitoring and in some cases treating the injury. But more than this, the coaching staff should ensure that a healthy and open dialogue regarding pain and injuries exists between and among the athletes and their teammates, coaches, parents and health practitioners.

Coaches and training staff should be aware that some of the sense-making strategies players use to assess pain can lead to responses that put them at greater risk of harm and further injury (such as hiding, prioritizing, and disembodying pain). Messages directed to the players should challenge the mentality that an athlete can or must return to play unless bound by physical barriers. A player should not return to the game once he can hold his hockey stick, but, rather, when he is no longer considered hurt medically. This change in mindset requires educating athletes and coaches about the implications of pain and injury beyond the sport itself (including potential long-term consequences). Parents and the coaching staff should be trained to recognize signs and symptoms of overtraining and fatigue and to educate their athletes on the importance of adequate rest and recovery. Furthermore, children should become familiar with the appropriate level of medical terminology to make their experience of pain or injury more concrete. Educating them on the nature of their symptoms (for example, muscle strain, ligament strain, delayed-onset muscle soreness) will assist them in identifying and describing their pain and thus avoid injury in the future.

We observed that all boys had at least a basic understanding of concussions and many understood the injury as not only affecting their ability to play hockey but also to function well in daily life. These findings, although based on a small sample size, are promising because they suggest that young athletes have the ability to comprehend the seriousness of head injuries. Furthermore, our results highlight the need for such a strategy to be geared toward other types of injuries that remain fairly misunderstood by young athletes in terms of their cause and effect.

In youth sport, chronic pain is of particular concern because it can signal an overuse injury that by definition should be preventable. Educating children about the physiological nature of recurring and chronic injuries at a level they can comprehend, and stressing its long-term consequences will, we hope, lead to a decrease in the worrisome rates of overuse injuries seen in youth sport (Bach and Shilling 2008). Finally, we believe that informing children about pain and injury not only helps them make sense of the pain, but serves to deconstruct the false sense of invulnerability that becomes associated with being an athlete.

Understanding how some boys make sense of pain in the context of minor ice hockey has provided greater insight as to why pain and injury in youth sport should be further investigated from a psychological as well as sociological perspective. Specifically, future research should observe whether or not variables such as the player’s skill level or status on the team are factors in the psychosocial process of making sense of pain and whether this is in turn related to or determined by the caliber of team (recreational vs. competitive). Future research could also compare these findings to an exclusively female ice hockey team to determine if girls have comparable understandings of sport-related pain and if they engage in similar pain discourse and behaviors.

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    • Search Google Scholar
    • Export Citation
  • CusimanoMichael D.Jane Topolovec-VranicStanley ZhangSarah J. MullenMattew Wong and Gabriela Ilie. 2016. “Factors Influencing the Underreporting of Concussion in Sports: A Qualitative Study of Minor Hockey Participants.” Clinical Journal of Sports Medicine. doi:10.1097/JSM.0000000000000372.

    • Search Google Scholar
    • Export Citation
  • DarlingScott R.Douglas E. SchaubelJohn G. BakerJohn J. LeddyLeslie J. Bisson and Barry Willer. 2011. “Intentional versus Unintentional Contact as a Mechanism of Injury in Youth Ice Hockey.” British Journal of Sports Medicine 45 (6): 492497.

    • Search Google Scholar
    • Export Citation
  • DochertySharron and Margarete Sandelowski. 1999. “Focus on Qualitative Methods: Interviewing Children.” Research in Nursing & Health 22 (2): 177185.

    • Search Google Scholar
    • Export Citation
  • EmeryCarolyn A. and Willem H. Meeuwisse. 2006. “Injury Rates, Risk Factors, and Mechanisms of Injury in Minor Hockey.” American Journal of Sports Medicine 34 (12): 1960–1969.

    • Search Google Scholar
    • Export Citation
  • EmeryCarolyn A.Willem H. Meeuwisse and Jenelle R. McAllister. 2006. “Survey of Sport Participation and Sport Injury in Calgary and Area High Schools.” Clinical Journal of Sports Medicine 16 (1): 2026.

    • Search Google Scholar
    • Export Citation
  • EsteveRosa and V. Marquina-Aponte. 2011. “Children’s Pain Perspectives.” Child: Care Health and Development 38 (3): 441452.

    • Search Google Scholar
    • Export Citation
  • FentonLindsay T. and Robert Pitter. 2010. “Keeping the Body in Play: Pain, Injury, and Socialization in Male Rugby.” Research Quarterly for Exercise and Sport 81 (2): 212223.

    • Search Google Scholar
    • Export Citation
  • GaffneyAnne and Elizabeth A. Dunne. 1986. “Developmental Aspects of Children’s Definition of Pain.” Pain 26 (1): 105117.

  • GourleyMeganne M.Tamara C. Valovich McLeod and R. Curtis Bay. 2010. “Awareness and Recognition of Concussion by Youth Athletes and Their Parents.” Athletic Training & Sports Health Care 2 (5): 208220.

    • Search Google Scholar
    • Export Citation
  • HarbeckCynthia and Lizette Peterson. 1992. “Elephants Dancing in My Head: A Developmental Approach to Children’s Concepts of Specific Pains.” Child Development63 (1): 138149.

    • Search Google Scholar
    • Export Citation
  • HarrisA. Christine. 1993. Child Development. Minneapolis, MN: West Publishing.

  • HoweGordie. 2015. Mr. Hockey: My Story (Berkley trade paperback ed.). Toronto: Berkley Books.

  • HoweP. David. 2001. “An Ethnography of Pain and Injury in Professional Rugby Union: The Case of Pontypridd RFC.” International Review for the Sociology of Sport 36 (3): 289303.

    • Search Google Scholar
    • Export Citation
  • HughesRobert and Jay Coakley. 1991. “Positive Deviance Among Athletes: The Implications of Over Conformity to the Sport Ethic.” Sociology of Sport Journal 8 (4): 307325.

    • Search Google Scholar
    • Export Citation
  • KellyKaren D.Heather L. LisselBrian H. RoweJoanne A. Vincenten and Donald C. Voaklander. 2001. “Sport and Recreation-Related Head Injuries Treated in the Emergency Department.” Clinical Journal of Sport Medicine 11 (2): 7781.

    • Search Google Scholar
    • Export Citation
  • KortesluomaRiitta-Liisa and Merja Nikkonen. 2004. “‘I Had This Horrible Pain’: The Sources and Causes of Pain Experiences in 4- to 11-year-old Hospitalized Children.” Journal of Child Health Care 8 (3): 210231.

    • Search Google Scholar
    • Export Citation
  • JaremkoMatt E.Lee Silbert and Thomas Mann. 1981. “Differential Ability of Athletes and Nonathletes to Cope with Two Types of Pain: A Radical Behavioral Model.” The Psychological Record 31 (2): 265275.

    • Search Google Scholar
    • Export Citation
  • LaurerHelmut L.Florence M. BareyreVirginia M.Y.C. LeeJohn Q. TrojanowskiLuca LonghiRachel HooverKathryn E. Saatman 2001. “Mild Head Injury Increasing the Brain’s Vulnerability to a Second Concussive Impact.” Journal of Neurosurgery 95 (5): 859870.

    • Search Google Scholar
    • Export Citation
  • MalcomNancy L. 2006. “‘Shaking It Off’ and ‘Toughing It Out’: Socialization to Pain and Injury in Girls’ Softball.” Journal of Contemporary Ethnography 35 (5): 495525.

    • Search Google Scholar
    • Export Citation
  • McCroryPaulWillem H. MeeuwisseMark AubryBob CantuJiri DvorakRuben J. EchemendiaLars Engebretsen 2013. “Consensus Statement on Concussion in Sport: The 4th International Conference on Concussion in Sport held in Zurich, November 2012.” British Journal of Sports Medicine 47 (5): 250258.

    • Search Google Scholar
    • Export Citation
  • MessnerMichael A. 2003. Taking the Field: Women Men and Sports. Minneapolis, MN: University of Minnesota Press.

  • MessnerMichael A. and Michela Musto. 2014. “Where Are the Kids?Sociology of Sport Journal 31 (1): 102122.

  • NemethRhonda L.Carl L. Von Baeyer and Eduardo Melani Rocha. 2005. “Young Gymnasts’ Understanding of Sport-Related Pain: A Contribution to Prevention of Injury.” Child: Care Health & Development 31 (5): 615625.

    • Search Google Scholar
    • Export Citation
  • NixonHoward L.II. 1992. “A Social Network Analysis of Influences on Athletes to Play with Pain and Injuries.” Journal of Sport and Social Issues 16 (2): 127135.

    • Search Google Scholar
    • Export Citation
  • NixonHoward L.II. 1993. “Accepting the Risks of Pain and Injury in Sport: Mediated Cultural Influences on Playing Hurt.” Sociology of Sport Journal 10 (2): 183196.

    • Search Google Scholar
    • Export Citation
  • PikeElizabeth C.J. 2004. “Risk, Pain and Injury: ‘A Natural Thing in Rowing?’” In Sporting Bodies Damaged Selves: Sociological Studies of Sports-Related Injury ed. Kevin Young151162. Boston: Elsevier.

    • Search Google Scholar
    • Export Citation
  • RoderickMartinIvan Waddington and Graham Parker. 2000. “Playing Hurt: Managing Injury in English Professional Football.” International Review for the Sociology of Sport 35 (2): 165180.

    • Search Google Scholar
    • Export Citation
  • RyanE. Dean and Charles R. Kovacic. 1966. “Pain Tolerance and Athletic Participation.” Perceptual and Motor Skills 22 (2): 383390.

    • Search Google Scholar
    • Export Citation
  • SaboDonald. 2004. “The Politics of Sport Injury: Hierarchy, Power, and the Pain Principle.” In Sporting Bodies Damaged Selves: Sociological Studies of Sports-Related Injury ed. Kevin Young5980. Boston: Elsevier.

    • Search Google Scholar
    • Export Citation
  • SafaiParissa. 2003. “Healing The Body in the ‘Culture of Risk’: Examining the Negotiation of Treatment between Sport Medicine Clinicians and Injured Athletes in Canadian Intercollegiate Sport.” Sociology of Sport Journal 20 (2): 127146.

    • Search Google Scholar
    • Export Citation
  • SingerRhonda L. 2004. “Pain and Injury in a Youth Recreational Basketball League.” In Sporting Bodies Damaged Selves: Sociological Studies of Sports-Related Injury ed. Kevin Young223235. Boston: Elsevier.

    • Search Google Scholar
    • Export Citation
  • StaffordAnneKate Alexander and Deborah Fry. 2013. “Playing Through Pain: Children and Young People’s Experiences of Physical Aggression and Violence in Sport.” Child Abuse Review 22 (4): 287299.

    • Search Google Scholar
    • Export Citation
  • StuartMichael J.Aynsley M. SmithJorge J. Nieva and Michael G. Rock. 1995. “Injuries in Youth Ice Hockey: A Pilot Surveillance Strategy.” Mayo Clinic Proceedings 70 (4): 350356.

    • Search Google Scholar
    • Export Citation
  • Tajet-FoxellBritt and F. David Rose. 1995. “Pain and Pain Tolerance in Professional Ballet Dancers.” British Journal of Sports Medicine 29 (1): 3134.

    • Search Google Scholar
    • Export Citation
  • TesarzJonasAlexander K. SchusterMechthild HartmannAndreas Gerhardt and Wolfgang Eich. 2012. “Pain Perception in Athletes Compared to Normally Active Controls: A Systematic Review with Meta-Analysis.” Pain 153 (6): 12531262.

    • Search Google Scholar
    • Export Citation
  • ThebergeNancy. 2008. “‘Just A Normal Bad Part of What I Do’: Elite Athletes’ Accounts of the Relationship Between Health and Sport.” Sociology of Sport Journal 25 (2): 206222.

    • Search Google Scholar
    • Export Citation
  • WillerBarryBeth KroetschScott DarlingAlan Hutson and John Leddy. 2005. “Injury Rates in House League, Select, and Representative Youth Ice Hockey.” Medicine & Science in Sports & Exercise 37 (10): 16581663.

    • Search Google Scholar
    • Export Citation
  • YoungKevin. 2012. Sport Violence and Society. New York: Routledge.

  • YoungKevin and Philip White. (1995). “Sport, Physical Danger, and Injury: The Experiences of Elite Women Athletes.” Journal of Sport and Social Issues 19 (1): 4561.

    • Search Google Scholar
    • Export Citation
  • YoungKevinPhilip White and William McTeer. 1994. “Body Talk: Male Athletes Reflect on Sport, Injury, and Pain.” Sociology of Sport Journal 11 (2): 175194.

    • Search Google Scholar
    • Export Citation

If the inline PDF is not rendering correctly, you can download the PDF file here.

Contributor Notes

Jacqueline Yeldon has a Bachelor of Kinesiology with Honors (Acadia University) and a Master of Science in Physical Therapy (University of Toronto). She has provided physiotherapy services to children of all ages with various orthopedic, neurological and developmental conditions in acute care hospitals, rehabilitation facilities and outpatient settings. E-mail: yeldon89@gmail.com

Robert Pitter is a Professor in the School of Kinesiology at Acadia University in Nova Scotia, Canada. He teaches about and conducts research on sport, physical culture, and media. E-mail: robert.pitter@acadiau.ca

Boyhood Studies

An Interdisciplinary Journal

  • BachGreg and Adam Shilling. 2008. “Research Update: Combating the Overuse Epidemic.” Parks and Recreation 43 (8): 2427.

  • ChouRogerRongwei FuJohn A. Carrino and Richard A. Deyo. 2009. “Imaging Strategies for Low-back Pain: Systematic Review and Meta-analysis.” Lancet 373: 463472.

    • Search Google Scholar
    • Export Citation
  • CoshColby. 2013. “The Real Danger in Hockey.” Maclean’s Magazine13 October. http://www.macleans.ca/society/the-real-danger-no-one-talks-about-2/.

    • Search Google Scholar
    • Export Citation
  • CraigKenneth D.Judith VerslootLiesbet GoubertTine Vervoort and Geert Crombez. 2010. “Perceiving Pain in Others: Automatic and Controlled Mechanisms.” The Journal of Pain 11: 101108.

    • Search Google Scholar
    • Export Citation
  • CurryTimothy Jon. 1993. “A Little Pain Never Hurt Anyone: Athletic Career Socialization and The Normalization of Sports Injury.” Symbolic Interaction 16: 273290.

    • Search Google Scholar
    • Export Citation
  • CurryTimothy J. and Richard H. Strauss. 1994. “A Little Pain Never Hurt Anybody: A Photo-Essay on the Normalization of Sport Injuries.” Sociology of Sport Journal 11 (2): 195208.

    • Search Google Scholar
    • Export Citation
  • CusimanoMichael D.Jane Topolovec-VranicStanley ZhangSarah J. MullenMattew Wong and Gabriela Ilie. 2016. “Factors Influencing the Underreporting of Concussion in Sports: A Qualitative Study of Minor Hockey Participants.” Clinical Journal of Sports Medicine. doi:10.1097/JSM.0000000000000372.

    • Search Google Scholar
    • Export Citation
  • DarlingScott R.Douglas E. SchaubelJohn G. BakerJohn J. LeddyLeslie J. Bisson and Barry Willer. 2011. “Intentional versus Unintentional Contact as a Mechanism of Injury in Youth Ice Hockey.” British Journal of Sports Medicine 45 (6): 492497.

    • Search Google Scholar
    • Export Citation
  • DochertySharron and Margarete Sandelowski. 1999. “Focus on Qualitative Methods: Interviewing Children.” Research in Nursing & Health 22 (2): 177185.

    • Search Google Scholar
    • Export Citation
  • EmeryCarolyn A. and Willem H. Meeuwisse. 2006. “Injury Rates, Risk Factors, and Mechanisms of Injury in Minor Hockey.” American Journal of Sports Medicine 34 (12): 1960–1969.

    • Search Google Scholar
    • Export Citation
  • EmeryCarolyn A.Willem H. Meeuwisse and Jenelle R. McAllister. 2006. “Survey of Sport Participation and Sport Injury in Calgary and Area High Schools.” Clinical Journal of Sports Medicine 16 (1): 2026.

    • Search Google Scholar
    • Export Citation
  • EsteveRosa and V. Marquina-Aponte. 2011. “Children’s Pain Perspectives.” Child: Care Health and Development 38 (3): 441452.

    • Search Google Scholar
    • Export Citation
  • FentonLindsay T. and Robert Pitter. 2010. “Keeping the Body in Play: Pain, Injury, and Socialization in Male Rugby.” Research Quarterly for Exercise and Sport 81 (2): 212223.

    • Search Google Scholar
    • Export Citation
  • GaffneyAnne and Elizabeth A. Dunne. 1986. “Developmental Aspects of Children’s Definition of Pain.” Pain 26 (1): 105117.

  • GourleyMeganne M.Tamara C. Valovich McLeod and R. Curtis Bay. 2010. “Awareness and Recognition of Concussion by Youth Athletes and Their Parents.” Athletic Training & Sports Health Care 2 (5): 208220.

    • Search Google Scholar
    • Export Citation
  • HarbeckCynthia and Lizette Peterson. 1992. “Elephants Dancing in My Head: A Developmental Approach to Children’s Concepts of Specific Pains.” Child Development63 (1): 138149.

    • Search Google Scholar
    • Export Citation
  • HarrisA. Christine. 1993. Child Development. Minneapolis, MN: West Publishing.

  • HoweGordie. 2015. Mr. Hockey: My Story (Berkley trade paperback ed.). Toronto: Berkley Books.

  • HoweP. David. 2001. “An Ethnography of Pain and Injury in Professional Rugby Union: The Case of Pontypridd RFC.” International Review for the Sociology of Sport 36 (3): 289303.

    • Search Google Scholar
    • Export Citation
  • HughesRobert and Jay Coakley. 1991. “Positive Deviance Among Athletes: The Implications of Over Conformity to the Sport Ethic.” Sociology of Sport Journal 8 (4): 307325.

    • Search Google Scholar
    • Export Citation
  • KellyKaren D.Heather L. LisselBrian H. RoweJoanne A. Vincenten and Donald C. Voaklander. 2001. “Sport and Recreation-Related Head Injuries Treated in the Emergency Department.” Clinical Journal of Sport Medicine 11 (2): 7781.

    • Search Google Scholar
    • Export Citation
  • KortesluomaRiitta-Liisa and Merja Nikkonen. 2004. “‘I Had This Horrible Pain’: The Sources and Causes of Pain Experiences in 4- to 11-year-old Hospitalized Children.” Journal of Child Health Care 8 (3): 210231.

    • Search Google Scholar
    • Export Citation
  • JaremkoMatt E.Lee Silbert and Thomas Mann. 1981. “Differential Ability of Athletes and Nonathletes to Cope with Two Types of Pain: A Radical Behavioral Model.” The Psychological Record 31 (2): 265275.

    • Search Google Scholar
    • Export Citation
  • LaurerHelmut L.Florence M. BareyreVirginia M.Y.C. LeeJohn Q. TrojanowskiLuca LonghiRachel HooverKathryn E. Saatman 2001. “Mild Head Injury Increasing the Brain’s Vulnerability to a Second Concussive Impact.” Journal of Neurosurgery 95 (5): 859870.

    • Search Google Scholar
    • Export Citation
  • MalcomNancy L. 2006. “‘Shaking It Off’ and ‘Toughing It Out’: Socialization to Pain and Injury in Girls’ Softball.” Journal of Contemporary Ethnography 35 (5): 495525.

    • Search Google Scholar
    • Export Citation
  • McCroryPaulWillem H. MeeuwisseMark AubryBob CantuJiri DvorakRuben J. EchemendiaLars Engebretsen 2013. “Consensus Statement on Concussion in Sport: The 4th International Conference on Concussion in Sport held in Zurich, November 2012.” British Journal of Sports Medicine 47 (5): 250258.

    • Search Google Scholar
    • Export Citation
  • MessnerMichael A. 2003. Taking the Field: Women Men and Sports. Minneapolis, MN: University of Minnesota Press.

  • MessnerMichael A. and Michela Musto. 2014. “Where Are the Kids?Sociology of Sport Journal 31 (1): 102122.

  • NemethRhonda L.Carl L. Von Baeyer and Eduardo Melani Rocha. 2005. “Young Gymnasts’ Understanding of Sport-Related Pain: A Contribution to Prevention of Injury.” Child: Care Health & Development 31 (5): 615625.

    • Search Google Scholar
    • Export Citation
  • NixonHoward L.II. 1992. “A Social Network Analysis of Influences on Athletes to Play with Pain and Injuries.” Journal of Sport and Social Issues 16 (2): 127135.

    • Search Google Scholar
    • Export Citation
  • NixonHoward L.II. 1993. “Accepting the Risks of Pain and Injury in Sport: Mediated Cultural Influences on Playing Hurt.” Sociology of Sport Journal 10 (2): 183196.

    • Search Google Scholar
    • Export Citation
  • PikeElizabeth C.J. 2004. “Risk, Pain and Injury: ‘A Natural Thing in Rowing?’” In Sporting Bodies Damaged Selves: Sociological Studies of Sports-Related Injury ed. Kevin Young151162. Boston: Elsevier.

    • Search Google Scholar
    • Export Citation
  • RoderickMartinIvan Waddington and Graham Parker. 2000. “Playing Hurt: Managing Injury in English Professional Football.” International Review for the Sociology of Sport 35 (2): 165180.

    • Search Google Scholar
    • Export Citation
  • RyanE. Dean and Charles R. Kovacic. 1966. “Pain Tolerance and Athletic Participation.” Perceptual and Motor Skills 22 (2): 383390.

    • Search Google Scholar
    • Export Citation
  • SaboDonald. 2004. “The Politics of Sport Injury: Hierarchy, Power, and the Pain Principle.” In Sporting Bodies Damaged Selves: Sociological Studies of Sports-Related Injury ed. Kevin Young5980. Boston: Elsevier.

    • Search Google Scholar
    • Export Citation
  • SafaiParissa. 2003. “Healing The Body in the ‘Culture of Risk’: Examining the Negotiation of Treatment between Sport Medicine Clinicians and Injured Athletes in Canadian Intercollegiate Sport.” Sociology of Sport Journal 20 (2): 127146.

    • Search Google Scholar
    • Export Citation
  • SingerRhonda L. 2004. “Pain and Injury in a Youth Recreational Basketball League.” In Sporting Bodies Damaged Selves: Sociological Studies of Sports-Related Injury ed. Kevin Young223235. Boston: Elsevier.

    • Search Google Scholar
    • Export Citation
  • StaffordAnneKate Alexander and Deborah Fry. 2013. “Playing Through Pain: Children and Young People’s Experiences of Physical Aggression and Violence in Sport.” Child Abuse Review 22 (4): 287299.

    • Search Google Scholar
    • Export Citation
  • StuartMichael J.Aynsley M. SmithJorge J. Nieva and Michael G. Rock. 1995. “Injuries in Youth Ice Hockey: A Pilot Surveillance Strategy.” Mayo Clinic Proceedings 70 (4): 350356.

    • Search Google Scholar
    • Export Citation
  • Tajet-FoxellBritt and F. David Rose. 1995. “Pain and Pain Tolerance in Professional Ballet Dancers.” British Journal of Sports Medicine 29 (1): 3134.

    • Search Google Scholar
    • Export Citation
  • TesarzJonasAlexander K. SchusterMechthild HartmannAndreas Gerhardt and Wolfgang Eich. 2012. “Pain Perception in Athletes Compared to Normally Active Controls: A Systematic Review with Meta-Analysis.” Pain 153 (6): 12531262.

    • Search Google Scholar
    • Export Citation
  • ThebergeNancy. 2008. “‘Just A Normal Bad Part of What I Do’: Elite Athletes’ Accounts of the Relationship Between Health and Sport.” Sociology of Sport Journal 25 (2): 206222.

    • Search Google Scholar
    • Export Citation
  • WillerBarryBeth KroetschScott DarlingAlan Hutson and John Leddy. 2005. “Injury Rates in House League, Select, and Representative Youth Ice Hockey.” Medicine & Science in Sports & Exercise 37 (10): 16581663.

    • Search Google Scholar
    • Export Citation
  • YoungKevin. 2012. Sport Violence and Society. New York: Routledge.

  • YoungKevin and Philip White. (1995). “Sport, Physical Danger, and Injury: The Experiences of Elite Women Athletes.” Journal of Sport and Social Issues 19 (1): 4561.

    • Search Google Scholar
    • Export Citation
  • YoungKevinPhilip White and William McTeer. 1994. “Body Talk: Male Athletes Reflect on Sport, Injury, and Pain.” Sociology of Sport Journal 11 (2): 175194.

    • Search Google Scholar
    • Export Citation