Stick to the Rules? Contact and Injury in Non-Contact Ringette

Background: Ringette is a fast-paced, non-contact ice sport played predominantly by females across Canada. While it shares similarities with ice hockey, ringette enforces strict non-contact rules. Despite this, ringette athletes may face significant injury risks, including higher concussion rates than their hockey counterparts (1, 2). However, there is limited large-scale data on injury and illness patterns in ringette, especially at the national level. The Canada Games is one of Canada’s largest amateur multi-sport events. Ringette was introduced to the Canada Winter Games in 1991 and is typically played over seven consecutive days. Understanding ringette injury and illness rates and mechanisms is an important first step in designing and evaluating potential prevention strategies. This study aimed to estimate illnesses and injury rates, locations, and mechanisms among ringette athletes who competed at the 2011, 2015, and 2019 Canada Winter Games. Hypothesis: N/A Methods: A retrospective cohort analysis was conducted using registration and medical reports from a larger dataset of athletes participating in the Canada Games covering 2009-2019. Data were classified using the 2020 International Olympic Committee consensus statement on sport injury/illness surveillance and the 2020 version of the Orchard Sports Injury and Illness Classification System. Incidence rates (IRs) with 95% confidence intervals (CIs) were calculated using Poisson regression, adjusted for clustering by contingent with robust standard errors and offset by exposure days. Results: Across three Games, 457 female athletes (ages 14–20) participated, contributing 3,199 athlete exposure days. In total, 123 injuries were reported as directly related to ringette IR: 38.45 (95% CI: 29.52–50.08) per 1,000 athlete-days. The most common injury locations included the back (20.33%), knee (16.26%) and shoulder (15.45%). The most common injury mechanism was contact (40.65%), followed by gradual onset (37.40%). There were 23 illnesses IR: 7.19 (95% CI: 4.82–10.73) per 1,000 athlete-days. Respiratory illnesses accounted for the majority of illness cases (60.87%). Conclusion: Approximately one in four female athletes required medical attention for ringette-related injuries during the Canada Winter Games. Contact injuries, overuse injuries, and respiratory illnesses were common. Despite ringette’s non-contact rules, the high number of contact injuries suggests a need to examine rule enforcement, equipment modifications, and contact training. The frequent occurrence of gradual-onset injuries may reflect both the access to care available during the Games and the possibility that athletes are competing with unhealed injuries, highlighting an opportunity to review competition schedules and injury management.