Elite Players Support Policy Allowing Body Checking in the Swedish Women’s Ice Hockey League: A Two-Year Cohort Study

Technical Summary: Elite Players Support Policy Allowing Body Checking in the Swedish Women's Ice Hockey League

Problem Statement
In 2022, the Swedish Women's Hockey League (SDHL) became the first elite women's league globally to permit body checking, a rule change framed as a gender equality reform. However, existing literature on men's and youth ice hockey indicates that introducing body checking is associated with a three-fold increase in game injury rates, particularly for concussions and contact-related injuries. Despite objective surveillance data showing a subsequent ~150% increase in overall injury rates in the SDHL, with body checking becoming the leading injury mechanism, the persistence of player attitudes toward this policy change remained unclear. The study addresses the disconnect between empirical injury data and player perceptions, specifically investigating whether elite female players' attitudes toward body checking and their perceived injury risk evolve over time as experience with the rule increases.

Methodology
This research utilized a two-year cohort design involving two survey waves conducted among SDHL players during the 2023–2024 and 2025–2026 seasons. The study population comprised players from all ten teams in the league.

• Data Collection: Electronic questionnaires were distributed via team sports managers and medical staff. The survey assessed physical characteristics (age, height, mass, BMI), playing background (position, prior experience playing on boys' teams), and attitudes toward body checking.
• Measures: Two primary questions assessed attitudes: (1) opinion on the introduction of body checking (categorized as positive vs. negative/unsure) and (2) belief that body checking increases injury risk (yes vs. no/unsure).
• Statistical Analysis:
  • Cross-sectional: Mixed-effects multivariable logistic regression models analyzed attitudes across both waves, adjusting for age, playing position, BMI, and prior experience playing with boys.
  • Longitudinal: A subset of 53 players who completed both surveys underwent within-player analysis. McNemar's test was used to summarize transitions in attitudes between waves.
  • Physical Characteristics: Linear mixed-effects models assessed changes in anthropometric data over time.
• Ethics: The study was approved by the Swedish Ethical Review Authority, with all participants providing informed consent.

Key Results

• Attitude Stability: Across both survey waves, the vast majority of players held a positive attitude toward body checking (89.2% in 2023–24; 95.6% in 2025–26). Statistical analysis revealed no significant change in the odds of reporting a positive attitude over time (adjusted OR = 0.45; 95% CI 0.14–1.44).
• Perceived Injury Risk: Most players did not believe that allowing body checking would increase injury risk (65.2% in 2023–24; 64.0% in 2025–26). There was no significant change in these beliefs over the two-year period (adjusted OR = 0.82; 95% CI 0.41–1.67).
• Longitudinal Transitions: Among the 53 players completing both surveys, no individual transitioned from a positive to a negative attitude. Five players shifted from negative/unsure to positive, while the majority maintained their initial stance.
• Physical Characteristics: No significant changes were observed in body height, mass, or BMI between waves. Furthermore, attitudes and risk perceptions were independent of age, playing position, BMI, or prior experience playing with boys.
• Demographic Shifts: The proportion of players born in Canada and the United States increased between waves, while the proportion from Finland decreased, though Sweden remained the primary country of birth.

Key Contributions
This study provides the first longitudinal evidence regarding elite women's ice hockey players' attitudes toward body checking following its introduction in the world's first professional league to implement the rule. The primary contribution is the documentation of a stable, positive player consensus over a two-year period, despite concurrent objective data indicating a substantial rise in injury rates. The study demonstrates that player perceptions of risk and acceptance are not driven by physical characteristics or prior exposure to male-dominated play, highlighting a divergence between subjective player experience and objective injury surveillance.

Significance and Claims
The authors claim that these findings highlight a critical disconnect between player perceptions and objective injury data. While players remain supportive and do not perceive an increased risk, surveillance data confirms a marked rise in injuries. The paper posits that this divergence underscores the necessity of integrating player perspectives with medical data, injury surveillance, and contextual resource factors when evaluating rule changes in women's sports.

The study explicitly refrains from taking a position on whether body checking should be permitted. Instead, it frames player attitudes as one essential component of the evidence base required for policy decisions. The authors emphasize that the introduction of body checking in the SDHL occurred without modifications to the rules used in men's hockey and without parallel investments in medical or organizational resources commensurate with the increased risk. Consequently, the study suggests that future policy development in women's ice hockey must balance the desire for gender equality in rules with the specific physiological and contextual characteristics of female athletes, ensuring that rule changes are supported by adequate injury prevention strategies and resource equity.