Discussion

Visor usage in the NHL continued to increase overall and among non-rookie players who had the option of using a visor. This increase occurred across all age groups. Several reasons could account for this growth including greater awareness of the risks of not wearing a visor and influence from teammates including leaders on the team that have adopted a visor. As minor and junior hockey leagues such as the Ontario Hockey League and the American Hockey League have mandated visors for all players, players coming to the NHL from the these leagues may have grown accustomed to playing with a visor and chose to keep it on as they were promoted to the NHL.

Previous studies from the NHL reported that players who did not wear a visor were found to be involved in more fights, hits and have more penalty minutes.2 ,5 This is consistent with our findings that skilled players—those who have more points, goals and assists—were more likely to wear visors and those who had more penalty minutes and played less games were less likely to wear a visor. The reason centermen had the greatest proportion of visor usage may be explained by their fewest penalty minutes. These findings suggest that players who do not wear visors have a more aggressive style of play consistent with the unwritten ‘code’ among hockey players who are discouraged from ‘hiding behind a visor’ when engaging in a fight or physical contact with another player.6 Given that skilled players serve as role models for amateur players and hockey fans throughout the world, optional safety measures taken by these players may promote safer practices in amateur organised and recreational leagues and result in fewer on-ice injuries.

Age was a negative predictor of visor usage, which is consistent with a previous study on the 2013–2014 season.3 Several factors likely explain this finding. First, older players entered the league during an era when visor usage occurred among fewer players. For example, in the 2001–2002 season, visor usage was found to be only 23%.2 Furthermore, compared with junior and professional hockey in the past the speed of the game has likely increased with the advent of light-weight equipment and with players becoming stronger. Therefore, players who played during an earlier time may have been at a lower risk of suffering facial injuries. Finally, older players may have played junior hockey when visor usage was not mandatory in these leagues. All of the aforementioned factors likely led these older players to grow accustomed to playing without a visor making change difficult in the later stages of their career. Interestingly, the few players that adopted a three-quarter visor were found to be older and have more favourable offensive statistics. These athletes may represent a subset of players who have previously suffered a serious facial injury and want to take added precautions to prevent another in the future. Future studies should aim to assess the effectiveness of these visors in preventing facial injuries. The high offensive statistics among these players suggests that there is no negative effect on on-ice performance.

A logistic regression model based on a combination of individual player statistics including age, games played, penalty minutes, goals and shots was built to determine the probability of a player choosing to wear a visor. These variables explained a significant amount of variation and can therefore be used to identify those players who have the highest risk of not wearing a visor. With this model, older players with lower offensive statistics can be specifically targeted for further research in this area. Future studies assessing the reasons for not adopting a visor in this group can provide valuable insight into this area and have implications for other areas of sports injury prevention. Educational campaigns among players can invest more effort towards this group of players. These strategies can include experiences from players who have suffered serious injuries, discussions from players who have recently adopted visors and talks from medical professionals regarding the long-term implications of facial injuries suffered on the ice.

The strength of this study was the inclusion of every professional hockey player who played one game during the 2014–2015 season. In addition, the use of in-game video and images allowed for first-hand acquisition of data. A limitation of this study was that three-quarter visors were identified by observing a player’s visor during in-game footage and not by obtaining the actual visor model. However, this was the only practical way of surveying all NHL players for three-quarter visor use. Additionally, since this is a cross-sectional study we cannot exclude the possibility of reverse causation. However, we feel that players are highly unlikely to significantly alter their style of play after either removing or wearing a visor. It is more likely that players develop a unique style of play throughout their career (eg, an enforcer, scorer, playmaker, etc) and that this, among other factors, influences whether or not a player will wear a visor.

Overall, visor usage continues to increase in the NHL independent of new legislation making it mandatory for rookie players to wear visors. Players who were more skilled, younger and played more games were more likely to wear a visor, whereas players who had more penalty minutes and less ice time were less likely to wear a visor. A small minority of players opted to wear a three-quarter visor and were much older in age and contributed more to their team's offence when compared with those players who wore a one-half visor. Future studies should aim to investigate the effectiveness of these visors in preventing facial injuries and motivations for not adopting a visor among older, more aggressive players.