More than 2 million boys and girls under the age of 18 are playing hockey in the United States. Several rule changes, technological advancements in equipment, and mandatory wearing of helmets and face masks have made hockey a safer sport for all to play and enjoy.

Hockey is a collision sport and injuries do occur. But with certified, quality, well-fitting equipment, the frequency and severity of these injuries can be decreased.

Helmets and face masks
Most hockey injuries occur to the head and face. Lacerations (cuts) to the skull and face, along with concussions, have been minimized by the mandatory wearing of helmets and face masks at most levels of play. In youth, high school, and college hockey, helmets and face masks are mandatory. 

When purchasing a helmet, make sure it fits snugly. Look for helmets with the seal of approval either from the HECC (Hockey Equipment Certification Council) or the CAHA (Canadian Amateur Hockey Association). Chin guards should always be worn; check the snaps frequently to ensure good working condition.

Face masks come in three styles: plastic visor, wire cage, or a combination of visor and cage. Wearing a helmet with a wire cage mask can protect your eyes from a high stick or a deflected puck.

Shoulder pads and chest protectors
Standard shoulder pads and chest protectors provide protection for the clavicle (collarbone) and upper arms, while giving you the ability to move freely on the ice and handle your stick. Several types of chest protectors include both the chest and the back as one piece.

Gloves and elbow pads
Your gloves must provide maximum protection without affecting your grip. The thumb, the palm, and the cuff of the wrist are often hit by opposing players' sticks. Purchase gloves with maximum protection over the thumb. Make sure the palm of the glove is soft, so you can feel the stick in your hand. The cuff of the glove should be flexible but still offer protection. Cuffs that run too far up the arm will hinder your flexibility. And make sure the laces of the gloves are always tied and in good condition.

Make sure your elbow pads fit well and cover the sides and the back part of the elbow.

Hockey pants
Most hockey pants today are manufactured with pads built inside to cover and protect the hips, thighs, kidneys, and tailbone. Properly fitted pants can prevent your pads from sliding out of place and exposing an area to injury. Your garter belt, which is used to hold your pants up, should be checked frequently for wear and tear.

Leg guards
Good leg guards have a knee cup pad, wrap-around padding to cover the sides of the knee, and wide side flaps. Make sure they are not too bulky and the length is correct.

Hockey stick
The hockey stick is the most important piece of equipment for a player. The top of the stick is known as the "butt," which leads down into the shaft (the long stem of the stick). Shafts are typically made of carbon graphite, aluminum, or wood. The curvature at the bottom of the shaft is known as the blade.

Sticks need to be fitted for players. Remember the "rule of chin": While wearing skates and placing the stick on the end of its blade, the butt of the stick should lie three inches under your chin. Sticks are made for either left- or right-handed players, depending on the curve of the blade. Restrictions regarding the size of your hockey stick vary depending upon the level of competition.

Skates
Skates are composed of three parts: a boot, a blade holder, and a steel blade. The boot is made of leather, nylon, or molded plastic. The surface of the steel blade is not flat, but curved inward. The sharpening process carves out the center of the blade, leaving two sharp surfaces. Keeping your skates sharp helps maneuverability and prevents you from catching your blade on the ice, which can lead to leg and knee injuries. Brand-name skates are your best bet. Make sure the skate has a well-constructed heel and ankle support. Wear only one pair of socks; bulky socks can hinder the snug fit of a boot.

Mouth guards and groin protection
Mouth guards are cheaper than dental bills. You can have them specially molded for you.

For groin protection, the larger, heavily padded, boxer-style cup is better than the traditional small plastic cup.

Goalie gear
As a goalie you need to be ready to stop slap shots of up to 100 mph. The goalie's equipment weighs approximately one-fourth of his or her body weight.

A goalie helmet and mask is usually made of fiberglass or KevlarT, the same material that bulletproof vests are made of. Masks can be form fitted to match the contours of your face, or you can use a cage-and-helmet combination. For younger goalies, the cage and helmet offers more protection. Most masks have a deflector pad that hangs down from the chin, protecting the neck and throat.

The newer goalie pads are made of synthetic materials that are stronger, lighter, and less absorbent than the old leather pads, but still offer excellent protection. Goalies require extra protection, especially around the arms, thighs, and tailbone. Special leg pads are worn, not only for protection, but also to give the goalie an additional blocking surface. There are restrictions on the width of leg pads, again depending upon the level of play.

The goalie also wears two different gloves. The catching glove looks like a first baseman's mitt. It has ample padding around the wrist and hand to protect against cuts and bruises. The backhand glove is a flat rectangular pad made of leather and usually covered with fiberglass. The palm of this glove is thin, allowing the goalie to maintain a firm grip on the stick.

The goalie stick is usually made of wood with a larger blade, measuring about three inches wide. This allows for a greater shot-blocking surface.

Practical tips
Penny-pinching is not wise when it comes to buying good protection. Go to a reputable sporting goods store that sells certified brand names. If you are going to buy used equipment, check it out carefully. Try the equipment on and make sure it all fits properly. Injuries occur when loose-fitting equipment slides out of the way of an oncoming puck.

Keep your gear well organized and stored in a well-ventilated, dry area. Check your equipment frequently for early signs of wear and tear. Make those necessary repairs before you get out on the ice. And remember the old saying: "Take care of your equipment and it will take care of you!"

P. Dean Cummings, M.D.
Columbus, Georgia