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.

US expect the world will eventually catch up with heading ban

Uefa said it would consider implementation which would apply to all under-10s

The US has already taken proactive action with a heading ban in place since 2015. Photograph: Getty Images

A top football executive believes the rest of the world will eventually catch up with the United States’ pioneering ban on heading in youth football.

The Professional Footballers’ Association has advocated the move, which would apply to all under-10s, and in January European football’s governing body Uefa said it would consider implementation if its own study provided sufficient evidence.

A major study into the long-term effects of heading and potential links to dementia and brain damage commissioned by the English Football Association and English PFA began two months ago but initial findings are not expected for at least three years.

However, the US has already taken proactive action with a ban in place since 2015.

Kevin Payne, the chief executive of US Club Soccer, national association member of the United States Soccer Federation principally involved in youth football, was involved in the discussions which led to restrictions being brought in.

“While there is not a lot of direct evidence or research which draws a straight-line correlation between heading a ball at young ages and potential issues later in life we think it is a logical assumption as younger children’s technique will not be as good and their brains are not as fully developed,” he said.

“Until such time as that research has been completed and there are conclusions to be drawn we thought it was much safer to err on the side of caution.

“When you are talking about someone’s brain it is a big deal and we need to be almost overly-protective in this area.

“Part of the issue is that no one really knows what are the consequences of heading a ball at this young age.

“Until we do know the answer the only responsible course of action is to do everything possible to minimize the chance of it creating problems.

A top football executive believes the rest of the world will eventually catch up with the United States’ pioneering ban on heading in youth football.

The Professional Footballers’ Association has advocated the move, which would apply to all under-10s, and in January European football’s governing body Uefa said it would consider implementation if its own study provided sufficient evidence.

A major study into the long-term effects of heading and potential links to dementia and brain damage commissioned by the English Football Association and English PFA began two months ago but initial findings are not expected for at least three years.

However, the US has already taken proactive action with a ban in place since 2015.

Kevin Payne, the chief executive of US Club Soccer, national association member of the United States Soccer Federation principally involved in youth football, was involved in the discussions which led to restrictions being brought in.

“While there is not a lot of direct evidence or research which draws a straight-line correlation between heading a ball at young ages and potential issues later in life we think it is a logical assumption as younger children’s technique will not be as good and their brains are not as fully developed,” he said.

“Until such time as that research has been completed and there are conclusions to be drawn we thought it was much safer to err on the side of caution.

“When you are talking about someone’s brain it is a big deal and we need to be almost overly-protective in this area.

“Part of the issue is that no one really knows what are the consequences of heading a ball at this young age.

“Until we do know the answer the only responsible course of action is to do everything possible to minimise the chance of it creating problems.

“There were some individuals who were not happy about it and I am sure there are still, the old guard who think it is silly not to allow heading.

“But we think we are ahead of the curve on this. We think it is very possible that other countries will end up having a little bit of the same thing.”

The regulations have a huge support structure behind them which helps coaches and parents diagnose and monitor injuries with any head trauma flagged up with a warning to seek medical attention.

Dev Mishra, an orthopaedic surgeon at Stanford University, founded Sideline Sports Doc which offers an online course to help injury recognition which has amassed 50,000 coaches and staff members in just over 18 months.

“If we could find a way for these coaches to have some of this basic recognition maybe we could reduce the severity of injuries, especially concussion,” said Mishra.

“How do you figure out this kid has had a concussion and how do you remove them from play so they don’t have another?

“It is a very simple four-step algorithm which attempts to mimic for a coach what we as trained physicians do on the field of play.”

Online tool Player’s Health tracks athletes’ injuries and has 150 organisations from universities and high schools to clubs signed up for a wide range of sports.

“When your athlete is displaying more than one head injury in six months there is going to be a notification that the parent/guardian should be mindful and we can inform them of specialist facilities near them,” said Tyrre Burks, founder and chief executive.

“The whole system is around alerting everyone. The parent is notified and their kid is not allowed to come back and play until they have that medical clearance uploaded into the system.”

The Irish Times 3/20/2018

Hitting the Slopes? Consider these Expert Recommended Safety Tips

By: Brian Rog and Laura Waller, ATC, LAT for ATI Physical Therapy

Hitting the Slopes? Consider these Expert Recommended Safety Tips

Gasping that brisk winter air as your snowboard seamlessly rips through that freshly-packed powder at supersonic speeds sounds fun, right? Few would argue, but a lesser attractive reality of high-risk winter sports like snowboarding and skiing is assumed well before these euphoric moments on the slopes.

Regardless of skill level, it’s important to know that while activities like snowboarding and skiing vary in technique, they both demand superior agility, strength, balance, response time and endurance. For those thrill seekers destined to conquer the mountain, failing to fuse these physical requisites into your day can land you in serious trouble.

Anyone who’s navigated the slopes, will tell you that the inherent dangers on the slopes can be minimized with a bit of knowledge and preparation. Looking at this deeper, a rider’s physical aptitude, gear and body mechanics such as stances and riding styles ultimately decide a day’s outcome.

Injuries during or after a day on the slopes can happen to anyone, but with a few simple measures, you can consciously assume control of your adventure and work to lessen these risks. As with any sport, the levels of risk, set against reward, teeters on your willingness to establish and commit to a routine.

Common ski and snowboard injuries

It should come as no surprise that within the ATI clinics, injuries credited to skiing typically involve hip arthritis, hip labral tears, and ACL/MCL sprains and tears (knee injuries account for 30 percent of all skiing injuries). Since these areas of the body endure the most load and changes in motion, a blunder in form or technique puts the lower extremities at increased risk.

With snowboarders, since the motions and stances are fundamentally different than skiing, our clinicians see more wrist and back injuries than any other ailments. When a boarder falls, instinctively, the hands are used as a first line of defense to break the fall, ultimately resulting in a fracture or sprain.

With back injuries, this comes with its own grouping of challenges. Since both feet are anchored to the board, you see a lot of falling either directly on the butt or on the stomach, which lead to a menu of conditions.

We are also seeing an increase in tendonitis among snowboarders because of the hopping required just to get moving down the slopes.

And the final, most overlooked ailment, is a concussion. As CTE (Chronic Traumatic Encephalopathy) gains attention among the athletic community, skiers and snowboarders are learning they are also not immune to the effects of this disease. Given the high speeds involved in the sport, that soft, snow-covered surface can wreak major havoc on the body upon impact. While a helmet can help protect the brain from a major impact, it may not completely defend against a concussion.

One final thing to note is that for skiers and boarders who have successfully rehabbed an injury, overuse injuries (specifically of the lower extremities) are leading to more chronic instability. With this, it’s important to recognize the risks and preventive measures to take. You can always reach out to your nearest ATI clinic for next steps in care and assessment.

Leading contributors to ski and snowboard injuries

Injuries in both disciplines commonly result from improper form, fatigue or acting outside your limits – like taking on a more advanced slope. With improper form, weaknesses among certain muscle groups tends to occur, resulting in injury. Conditioning the larger muscle groups is not enough for these sports – it’s important to work on the smaller, more stabilizing muscles to retain peak performance.

Balance is also an important factor. The more stability and body awareness you have, the better your form, and the lower your chances become for muscle soreness and strains.

Ski and snowboard safety gear to consider

Above all else, the most important item to wear when skiing and snowboarding is a helmet. To be most effective, the helmet must be intended for snow sports – not biking, skateboarding, rollerblading, etc.

With the appearance of major concussions and probability of CTE, the industry has stepped up in big ways to produce helmets aimed at protecting the brain from major traumas. Of these advancements, most companies now manufacture helmets that feature the innovative Multi-Directional Impact Protection System (MIPS), which helps to protect against rotational motions transmitted to the brain from angled impacts to the head. So when choosing a helmet, make sure it is MIPS-equipped.

When considering braces and padding, it’s important to remember that while snow is relatively soft, it can still be unforgiving. With this, our specialists recommend wearing knee guards or braces, back protectors, wrist guards and protective shorts to support and cushion the impact of a fall. These items will also help to shield areas of the body that are most susceptible to injury.

Muscle groups deserving attention before hitting the slopes

Stretching before a day on the slopes can be the difference between a more agile and flexible ride or a more stiff and strenuous one. When stretching, be sure to focus on your hamstrings, IT band, hip flexors, calves, glutes, ankles, back and neck. These stretches should be done as dynamically as possible.

More specifically, consider incorporating squats, lunges, side lunges, hip rotations, upper body rotations, donkey kicks and fire hydrants. These exercises target mobility and flexibility, which help to support function, form and performance. If you have your own warm up routine that focuses on the areas of the body listed above, but doesn’t follow our suggested exercises, no problem – stick with it.

If you are planning a full day on the slopes, a good rest period should entail increments amounting to at least two hours. Taking enough time to make sure you can refuel your body correctly with food and possibly a nap (not to mention hydration) will give your body the recharge it needs. Most resorts have a lodge to set your equipment and an area to snack and rest.

A recommended ratio would be 3:1 hours of activity to rest. For those who only spend a few hours on the slope, just be sure to incorporate, at minimum, several 30-minute rest periods.

Stretching after a day on the slopes

You are exhausted, sore and fatigued, and the last thing you want to do is demand more of your muscles. But if you want to reduce soreness in the hours and days to come, stretching after a day on the slopes must be a priority. This will help maintain your mobility and ease muscle soreness during the recovery period.

In doing this, we recommend using a foam or handheld roller and rolling out the lower body to help loosen your muscles and reduce tissue tension. Rolling out to get the massage effect before stretching will allow for a deeper, better stretch. It’s also beneficial to take a warm shower after you roll out as it’ll help to complement your rolling efforts. After a shower is the best time to incorporate your stretches because that is when the deepest stretches will occur due to increased blood flow and muscle warmth.

If these options are readily accessible, just make sure your program targets the hamstrings, calf muscles, glutes, spine, rotators, quadriceps, and thighs. ATI specialists encourage people to stretch out what they feel like they need to stretch out after any activity, but given the lower body demands of these two activities, the lower body takes a lot of strain, so more emphasis is placed on that area.

Recover like an Olympian

Recognizing and assessing an injury is the first step in ensuring a speedy and effective recovery. Most individuals are led to believe that surgery or opioids are their only lines of defense when dealing with an injury. Instead, consider physical therapy as a first course of action, even if it’s only a screening, which are complimentary at all ATI locations. Recent research suggest that people who underwent physical therapy enjoyed faster recovery and less pain than those who chose alternative routes such as surgery and opioids. Give PT a try!

Donor Family Shares Story of Hope; Zach Miller Knee Injury; Cheerleader Injuries

Episode 17.30 Rerun

Segment One (01:30): The Healing Process of Donor Parents Lori and Rob Chana.

Cameron Chana (2)Cameron Chana was a born leader who focused on making an impact in lives of others. He was very involved in volunteer work, his church, and went on mission trips across the world. No matter where he was, he encouraged positivity and spread his caring, upbeat energy.

The Chana family’s world was turned upside down when twenty-two-year old Cameron was killed in a bus accident in 2009. During a time of unimaginable grief, his parents and three siblings honored his wish to be a donor.

Cameron’s legacy of hope and love lives on through the gift of organ and tissue donation. He saved five lives through organ donation and impacted as many as 50 lives through tissue donation. Learn more at AllowSource.

Lori & Rob Chana with Steve and Dr. Cole

Chana family with Cameron on the Left

Cameron’s heart recipient


Segment Two (14.12): Steve and Dr. Cole talk with former Chicago Bear Otis WilsonUSP NFL: CHICAGO BEARS AT NEW ORLEANS SAINTS S FBN NO CHI USA LA about Zach Millers horrific knee injury in the recent game against the New Orleans Saints. Chicago Bears Zach Miller had emergency surgery last week to repair a torn popliteal artery in his left leg, an injury that has resulted in amputation in some previous instances involving other football players. The 33-year-old dislocated his left knee while trying to catch a touchdown pass, which subsequently damaged the artery.


Segment Three (21:04): Dr. Kathy Weber from Midwest Orthopaedics at Rush talksabout the prevalence of catastrophic injuries and concussions in cheerleaders. Cheerleading is by far the most perilous sport for female athletes in high school and college, accounting for as much as two-thirds of severe school-sports injuries over the past 25 years, according to a new report. Yet cheerleading remains one of the least-regulated sports, despite more than 95,000 high school girls and 2,000 boys signing up for spirit squads nationwide each year.


kathleen weberDr. Weber’s reputation as a leading sports medicine physician is enhanced by her remarkable activity in the treatment of high-level professional athletes. She serves as the head primary care sports medicine team physician for the Chicago Bulls and the Chicago White Sox and the head team physician for the Chicago Force Women’s Football. She also serves as co-head team physician for the DePaul Blue Demons and the physician for the Hubbard Street Dance and the River North Dance Companies. In addition, she is a member of the LPGA Medical Advisory Board. She is on numerous committees including the NBA Team Physicians Executive Committee, NBA Research Committee, MLB Concussion Committee, and MLB Research Committee. Dr. Weber has been involved with the MLB Medical Advisory Board for multiple years and is the first women elected President of the MLB Team Physicians Association.