close up of two hockey players on the ice

The Penalty for Hockey’s Enforcers May Be Premature Death

Longtime National Hockey League fans probably remember Bob Probert, the hulking “enforcer,” whose main role was to protect his teammates with physical force. Over his 17-year pro career, Probert engaged in 285 fights—one every four games.

Probert apparently paid a high price for his brawling style of play. He died of a heart attack in 2010 at the age of 45, but an autopsy also found evidence of damage to the brain in the form of chronic traumatic encephalopathy (CTE), a neurodegenerative disease linked to repeated head trauma.

Among hockey enforcers, Probert’s death is not unique, according to new study by researchers at Columbia University Vagelos College of Physicians and Surgeons.

In their study of more than 6,000 NHL players from 1967 to 2022, the researchers found that enforcers (defined as those who had 50 or more career fights) died a decade earlier on average compared to their less pugilistic peers (those with a career average of 7 fights). In addition, the enforcers were more likely to die of suicide and drug overdose, common occurrences in people with CTE.

The study, the first to examine the long-term health consequences of fighting in ice hockey, was published last month in JAMA Network Open.

Dr. Charles Popkin, a team physician with USA Hockey, on the ice

Charles Popkin is a Columbia University orthopedic surgeon and a team physician with USA Hockey. Photo courtesy of Charles Popkin.

“Clearly, fighting is a serious health risk,” says lead author Charles A. Popkin, MD, associate professor of orthopedic surgery at Columbia and a team physician for USA Hockey. “Our findings are in line with what we’ve seen in the National Football League, where studies have linked high rates of concussion to CTE and premature death.”

Fighting is in decline in the NHL, down from 1.3 fights per game in 1987, the peak of hockey’s enforcer era, to 0.19 fights per game in the season before COVID, according to

“Nonetheless, the league should do more to reduce fighting even further,” says Popkin, a lifelong hockey fan who grew up playing the game in Minnesota.

He urges the NHL to increase penalties for fighters, with automatic ejections, followed by immediate concussion evaluations, and even harsher suspensions for repeat offenders. Fighting is rare in the International Ice Hockey Federation, the Olympics, college hockey, and many European professional leagues, where engaging in fisticuffs is met with a game misconduct penalty, among hockey’s most serious punishments.

“The NHL should follow the example set by these organizations,” Popkin wrote in 2022 Boston Globe opinion piece. “Player safety should be at the forefront of the league’s agenda, and it should immediately change the rule. It’s a worthwhile investment in the players and the long-term health and viability of the game.”

In 2011, the NHL amended Rule 48.1, making any hit to the head a penalty. “But the punishment was subsequently softened,” says Popkin, “and it falls short of what is needed to protect player health.”

Charles Popkin, MD

Charles Popkin

Making further changes to the game will not be easy, he adds. “Hockey is a warrior culture. Many of the ‘old guard’ argue that fighting serves as a deterrent to even greater violence, motivates teams to win games, and promotes attendance. None of those is true, by the way. Despite two decades of declining fighting rates, the game remains as popular as ever.”

Still, Popkin is optimistic that hockey will change. “The enforcer has been dying a slow death,” he says.

“Most teams aren’t carrying an enforcer unless they can bring another skill to the ice. We’ll probably never eliminate fights. But if players choose to throw down their gloves, they should at least understand the long-term ramifications to their health.”


More information

Citation: Popkin CA, Morrissette CR, Fortney TA, McCormick KL, Gorroochurn P, Stuart MJ. Fighting and Penalty Minutes Associated With Long-term Mortality Among National Hockey League Players, 1967 to 2022. JAMA Netw Open. 2023 May 1;6(5): e2311308. DOI 10.1001/jamanetworkopen.2023.11308.

Author affiliations: Charles A. Popkin (Columbia), Cole R. Morrissette (Columbia), Thomas A. Fortney (Columbia), Kyle L. McCormick (Columbia), Prakash Gorroochurn (Columbia), Michael J. Stuart (Mayo Clinic).