Ice Hockey Injury Awareness and Prevention

By Brian Rog and Katie Christopherson, ATC for ATI Physical Therapy

Ice Hockey Injury Awareness and Prevention from ATI Physical Therapy

Behind any sport’s glory lies a complex algorithm so delicate that even the slightest miscalculation in training or performance can cut a practice, game or season short. High-intensity, year-long sports like ice hockey, adhere to a very complex set of rules due to the on-ice demands and endless fitness requisites. In keeping up with these standards, as a player, coach or parent, it’s important to be educated on gear safety, strength & conditioning, skating technique and return to play rehab protocols.

With the help of ATI Physical Therapy athletic trainer and seasoned hockey player, Katie Christopherson, we’ll take an inside look into common hockey injuries, injury prevention tips and stretching recommendations to help you relish the game and all its glory. Adding to this, our friends at ProStockHockey supplied us with an insightful upper body injury infographic , which underscores the importance of choosing the right equipment.

What are the more common hockey injuries treated in the clinics?

When it comes to hockey injuries, regardless of age and skill level, we commonly see injuries to the head, shoulders, hips, knees, feet, and ankles. Injuries linked to the body parts mentioned above can be assessed and rehabbed in a physical therapy clinic. Head injuries are an exception to this as most rehab clinics are not staffed with head injury specialists. However, at select ATI locations, we have specialists credentialed to treat head injuries and their accompanying hindrances.

Within the sport, hockey injuries are traditionally classified as either chronic (overuse) or acute (more traumatic). So when you hear of a player suffering ‘an acute concussion’, you’ll know the level of injury the athlete is dealing with. Looking deeper into these common hockey injuries, here’s a breakdown of the top-4 and their contributors:

Shoulder injuries

It is common to find rotator cuff and glenohumeral (ball and socket joint) injuries being treated in clinics.  The rotator cuff is a group of stabilizing muscles that are frequently used with stick handling in hockey.  Shoulder dislocations and AC joint sprains are common due to checking in hockey as well and require physical therapy to correct.

Hip injuries

In the hip, you will find a lot of groin muscle strains due to a misstep in skating or getting caught up in the boards or another person’s leg or stick.

Knee injuries

In the knee, our clinics more commonly see MCL sprains and/or meniscus tears, which result from twisting of the knee or direct impact to the outer side of the knee.

Head injuries

Given the full-contact nature of hockey, it’s no surprise we see a steady stream of head injuries such as concussions. Head injuries can have very serious consequences and require immediate medical attention, so don’t ignore the warning signs.

How can a hockey player lessen the risk of injury? 

To help lessen the risk of injury, a player must undergo proper training, wear sized-appropriate protective gear, and follow proper rehab protocols when returning from an injury.  Before tackling this checklist, it’s important to know that roles will vary according to a player’s position on the ice, whether it be a forward, defensemen or goalie.  These roles vary by position, so following position-designated strengthening, skating technique, gear, and return-to-play rehab protocols will help you better adapt to role-specific scenarios.

For instance, if you are a forward, the position does not demand as much backwards skating as a defensive position, however both positions utilize forward-skating crossover techniques, so in some cases you’ll borrow tactics from other positions.

Irrespective of position assignment, it’s strongly suggested that as players move through the ranks they should work towards a versatile role, meaning they can assume the duties of a defenseman (or forward), if needed. Doing this helps a player better adapt to varying on-ice challenges, both physically and mentally. The anomaly to this versatility rule is, of course, the goalie, since this position will never assume the role of a d-man or forward. On the flip side, you won’t see a skater step into the crease, unless of course you are Kris Russel of the Edmonton Oilers who holds the record for most blocked shots in one game at 15.

Since we are talking goalies, which is by far the most unique and laborious position on the ice, let’s take a look at what we know and have seen as far as injuries and conditioning strategy. Given the dynamic duties of a goaltender, we most commonly treat hip injuries resulting from squatting positions, quick side-to-side transitions and knee-to-ice movements that necessitate major hip rotations.

Similar to a forward or defenseman, a goalie must also understand the mechanics of the position and the levels of mobility needed to meet the grueling demands of the position. What makes this position even more unique is that on top of recognizing one’s own mechanics and strategies, a netminder must also learn the mechanics and strategies of a skater to better prepare their physical responses.

Once you’ve identified your role on the ice and importance of training and rehabilitation guidelines for each position, it comes time to establish a more thorough, role-specific training and injury-prevention program. For a forward or defenseman, this program must combine a focus on strength, speed, flexibility and endurance. With a goalie, their program should be similar to their teammates, however, he/she must follow a program that has an increased focus on flexibility, strength and endurance.

Avoiding injuries with the proper gear

The main thing to remember when outfitting yourself (or someone else), is to make sure the gear is appropriate for the position (i.e., skater vs. goalie) and that it fits properly. With this, you must also consider proper stick lengths and shape as well as the way a hockey skate fits and the skate’s blade radius. And yes, even the sharpness of the hockey skate blade can affect the player due to on-ice variables such as one’s position and softness/hardness of the ice.  Making yourself and others aware of these things and taking appropriate action can help to lessen the severity and occurrence of on-ice injuries. For helpful tips on properly outfitting your equipment, check out this hockey equipment fitting guide from the experts at Dick’s Sporting Goods.

Corrective stretches that can help to minimize injury risk 

Research has proven that including dynamic (mobility stretches) and static (stationary stretches) stretches will not only improve your endurance and balance, but will also lessen the risk of injury. While the aforementioned benefits are well known across the athletic community, the timing of the stretches (warm up/post-game) are commonly up for debate. ATI’s physical therapy experts suggest focusing on dynamic stretches before hitting the ice and static once finished, which include:

Dynamic stretches before hitting the ice

Dynamic hockey warm-ups, which are great for getting the heart rate up and enhancing range of motion and power, can be done on land (without gear) or can be done once you hit the ice.  Some beneficial flat-land warm ups include exercises such as high knees, hip swings, arm swings, butt kicks, karaoke, side steps and ankle hops. For dynamic on-ice exercises, consider hip circles, arm circles, leg swings, Cossack squats and trunk rotators.  The warm-up should take around 15 to 20 minutes all together and does not need to include static stretches as this will not help elevate your heart rate, which is an essential ingredient to priming the muscles for activity.

Static stretches after a game or practice 

Hockey players of all levels incorporate some form of static stretching after a game or practice without gear. The post-activity stretch is key in preventing injuries as it helps with maintaining flexibility and lowering recovery time. Examples of static stretches include, reaching for toes (hamstring), butterfly (groin), hollywood or secretary stretch (low back), flamingo (quads), lunge stretch (hip flexors), piriformis (hip/glutes), and IT band stretch (side of leg/hip).  These are all important in supporting flexibility and helping stay injury-free.

Preventing an overuse injury

There are multiple steps a skater can take to help prevent an overuse injury.  First off, as is the case in all sports, proper training is the cornerstone for achieving peak performance and fitness levels. In doing this, avoid going from minimal levels of activity to a high level as your chances of injury or muscle strain are significantly increased.

When training, also pay close attention to your form when doing cross-overs, skating backwards, and working on shooting technique. Over time, improper form places unnecessary loads on the muscles, causing them to break down. As a result, recovery times become lengthy and rehab programs exhausting.

This brings us to our last point on the role warm-ups and post-activity stretching play in shielding your muscles from injury. Including some form of dynamic warm-up before activity as well as static stretches afterward can be very beneficial for muscle sustainability, wellness and recovery. It’s been stated that well-structured warm-ups and stretches will get your heart rate and muscles ready to handle a heavy load while post-activity stretching allows your heart rate to decrease, causing your body to idle down into a resting state.

Managing hockey injuries, aches and pains

ATI experts strongly encourage athletes to take care of any minor aches and pains before they compound and get worse.  This can be as simple as heating for 20 minutes before activity and icing for 20 minutes after activity when the athlete feels soreness in one particular area.  If the pain persists, it might be a good idea to call your physician or visit your nearest ATI physical therapy clinic. In fact, at ATI, we offer complimentary injury screenings, so stop in and see what we can do for you.