Helmet and Gloves

“Helmets and Gloves” is an activity of adolescents in which two opponents don gloves and helmets with cages and proceed to strike one another about the head. It is experienced by both lacrosse and hockey players, but has spread beyond these populations. We present three illustrative cases of adolescent hockey players’ experiences with Helmets and Gloves; in one instance the end result was a clinically confirmed concussion. Concussion is an important topic of concern within the sports medicine and neurology communities.1–4 We wish to draw attention to this unusual adolescent, risk-taking behavior. Physicians involved in the care of adolescent athletes, parents, and sports administrators should be aware of, and address this emerging activity. Increased awareness of Helmets and Gloves may allow us to prevent unnecessary concussions and their consequences. A 15-year-old ice-hockey player was participating in a hockey tournament. One hour before game time he and four or five teammates retired to an empty locker room to play Helmets and Gloves. He remembers hearing a teammate say “There's a haymaker,” and being hit. He next remembers finding himself on the ground. He was reported to be unconscious by his teammates for 30 sec to 10 minutes. During this time, no one went for help. Upon awakening he had a pounding headache, dizziness and blurred vision. He played his next hockey game, but with a diminished level of performance. He missed two days of school because of headache symptoms, which persisted for a total of four to five days. He denied any change in school performance. He was subsequently seen in consultation for concussion. A 13-year-old ice hockey player had experienced two previous concussions within the preceding four months. Following a summer practice, he was playing Helmets and Gloves with a larger adolescent (15–22 kg heavier). He remembers an uppercut, then nothing further. His parents were called to the locker room by a teammate. When his parents arrived, most of the hockey players had left the locker room. The parents described their son as complaining of dizziness, his behavior was stunned, and assistance was required for him to walk. There was no disclosure of the circumstances of the injury at the time. He took days to return to his usual self. His history of concussions came to light months later during a sports medicine consultation for back pain. In a subsequent neurological consultation, the history of the locker room Helmets and Gloves event was obtained only when he was asked directly about this specific activity. He reported that in previous games of Helmets and Gloves his opponents (teammates) have become dazed after being struck, but have not lost postural tone. A 14-year-old female member of an Under 15 ice hockey travel team was at a hotel along with an Under 17 girls team from the same organization. She was told by a teammate that two of the Under 17 girls were going to play Helmets and Gloves and that she should watch. There were 12–15 observers from both teams in the room observing the bout. After getting hit, one of the participants fell limply to the ground and was unresponsive. At this time, the male coach came to the door to tell his players to settle down because of the noise. Before the door was opened, the observers dragged the unconscious player between a bed and the wall, so as to be invisible to the coach. After the coach left, the player regained consciousness, but was unsteady and required assistance to get up on her feet. She played hockey the next day. We were unable to find any description of this activity within the medical literature. Given the secrecy surrounding playing “Helmets and Gloves,” we used the Internet to discover whether any descriptions of this behavior existed in this alternative media. We searched Google (www.google.ca), Ixquick (www.ixquick.com), and Dogpile (www.dogpile.com) using the search terms “helmets and gloves,” “locker boxing,” and “helmet boxing”. We were able to find many descriptions of this activity, primarily within discussion groups. Helmets and Gloves probably has its origins in hockey and lacrosse locker rooms.5,6 It has been reported to take place wherever adolescents gather including garages, basements, hotel rooms and dormitories. Helmets and Gloves (also known as “locker boxing” and “helmet boxing”)7 has been described as a “time-honored test of manhood,”8 “a lot of fun,”9 and “one of the things I look forward to every season”10 by observers and participants. It is seen as a test of the toughness needed to play hockey and/or lacrosse. Opponents, usually teammates, wear helmets with cages and hockey or lacrosse gloves. Only head shots are allowed.11 Matches consist of up to three rounds,6 and are concluded by the “first to break” or when a helmet is knocked off.12 Some participants seem to be aware of the adverse outcomes associated with this activity, specifically the risk of concussion.13,14 Other injuries such as cuts by skate blades have also been described, e.g., “This kid cut his face open on a skate. It was pretty nasty but locker boxing is cool.”15 Other participants seem to downplay the risk; “we keep it safe and organized.”16 Helmets and Gloves has also been reported in an internal publication of an American university's ice hockey program,17 and has a specific website devoted to it in Canada.18 It is described by observers and participants in discussion groups as being tolerated19 and even encouraged20 by lacrosse coaches. A few hockey programs within the USA have specifically prohibited this risk-taking behavior, and identified its hazards in player conduct documents.21–24 In one of these programs a clear link between hazing and Helmets and Gloves is established.24 Irwin 25 used the term risk-taking to describe patterns of behaviors initiated during adolescence, which may have potentially adverse effects on health. Adolescent athletes have specific profiles of risk-taking behavior for general health risks, 26–33 as well as sport-specific risk-taking behaviors.26 Adolescents display a considerable range of judgment with regard to risky behaviors.34 For many adolescents engaged in risky behavior, a complete appreciation of their exposure to harm is lacking.35 Risk compensation36 is a concept that suggests that protective equipment may promote more aggressive play, and consequently, the risk of injury. A review of pediatric injuries in ice hockey38 provides a description of a widely held view of risk compensation, “Players now perceive themselves to be immune to injury and are willing to take risks with respect to their personal safety and that of their opponents.” Nearly half of injured hockey players (age 7–18 years) felt brain injury was not possible because of their protective equipment.39 This seems to be supported by the comments of Helmets and Gloves participant's,16 and their practice of concluding or suspending a bout when a helmet is knocked off. An additional safety issue is raised when participants differ in size. This is often seen in conjunction with the variable timing of the growth spurt,40 particularly for children aged 12–13 years, where there may be in excess of a 100% body mass difference.41 What motivates these participants? Peer group is important to adolescents,42 and adolescent peer group affiliation is closely tied to behavior.43 Do they participate to fit in? Is there sufficient peer pressure for this to constitute hazing? Monitoring may be critical in altering the malevolent influence of the peer group.48 This approach provides a potential intervention model for parents and sport officials concerned about Helmets and Gloves as a risk-taking behavior. Coaches should discuss the risk involved in this behavior with all athletes entrusted to their care and be clear in condemning these practices. Coaches or team staff should be the first in the locker room and the last to depart from a locker room.49,50 Hockey and lacrosse administrators should ensure their policies specifically address this risk-taking behavior.21–24 Hockey Canada's Rule 47 is inclusive of behavior such as Helmets and Gloves: “Team officials shall be responsible for their conduct and that of their players at all times. They must endeavor to prevent disorderly conduct before, during or after the game, on or off the ice and anyplace in the rink.”51–53 Helmets and Gloves or “locker boxing” is an adolescent risk-taking behavior with significant potential for concussion. Our data is observational, and is validated only by the convergence of the various descriptions on the Internet with the descriptions provided by our cases. Parents and coaches of adolescent athletes should discuss the risk involved in this behavior with their charges. Adolescent hockey and lacrosse teams should be closely monitored in locker room environments and while traveling for competition. Administrators should review and enforce policies regarding player conduct and locker room behavior. Medical practitioners assessing athletes with concussion symptoms and signs, but without a witnessed or declared impact, should specifically raise questions about participation in Helmets and Gloves.

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