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.

FAI Patients Who Practice Yoga Respond Well to Surgery

person doing yoga

Femoroacetabular impingement (FAI) is a painful hip condition that is most often diagnosed in younger patients who perform activities that require hip flexibility, like yoga. In patients with FAI, extra bone develops along the acetabulum (socket of the hip) or on the femoral head (ball of the hip). This bony overgrowth damages the soft tissues of the hip during movement. This condition can be effectively treated with hip arthroscopy, a surgical process during which a small camera and tiny instruments are inserted into a narrow incision to treat the affected area.

Midwest Orthopaedics at Rush hip arthroscopy specialist, Dr. Shane Nho, has been following hip arthroscopy patients who practice yoga to identify at what rate they returned to yoga after the procedure. The study reported that a full 93% of patients were able to return to yoga approximately 6 months post-surgery.

See the full study published in SAGE Journals here.

Does Hip Arthroscopy Work for Hip Impingement?

Dr. Shane Nhosports medicine and hip arthroscopy specialist at Midwest Orthopaedics at Rush, recently published a study further proving that arthroscopic hip surgery is an effective treatment for femoroacetablular impingement (FAI), a hip condition in which the ball shaped femoral head in the hip rubs abnormally or does not permit a normal range of motion in the acetabular socket. This condition occurs most often in young to middle aged patients.dr shane nho

The study, “Hip Arthroscopic Surgery for Femoroacetabular Impingement with Capsular Management: Factors Associated With Achieving Clinically Significant Outcomes,” was published in The American Journal of Sports Medicine. It looked post-operatively at 386 patients undergoing primary hip arthroscopic surgery with routine capsular closure for FAI that had failed nonsurgical management between January 2012 and January 2014.

In this Orthopedics This Week article, he says, “The field has been evolving over the past several years and the patient selection and surgical technique has also changed. Our paper is the largest series in the literature and represents the state of the art in hip arthroscopy for the treatment of femoroacetabular impingement.”


Read the entire article here.

For more information on hip arthroscopy, click here.

Proper Training Shoe Selection; When is Surgery not an Option?; Bone Loss & Osteoporosis

Episode 17.16 with Hosts Steve Kashul and Dr. Brian Cole. Broadcasting on ESPN Chicago 1000 WMVP-AM Radio, Saturdays from 8:30 to 9:00 AM/c.

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Segment One (01:31): Steve and Dr. Cole talk with Perry Miroballi, the Co-Owner of New Balance Fresh Foam 822v3 Trainer, Pisces with Black & Poisonberryfour New Balance Stores, about proper athletic shoe selection; providing video analysis and foot scans to determine pressure points and arch type; the wide variety of sports specific shoes that are now available from New Balance and the advancements in New Balance shoe technology. More than 500 major league baseball players now wear New Balance Shoes and they now make a golf shoe that is only 7 ounces, the lightest shoe in golf.


Segment Two (12:52): Steve and Dr. Cole talk about a wide range of non-surgical options for pain and orthopedic problems and how the art of medicine serves to determine the right approach to treating injuries.


Segment Three (20:08): Steve and Dr. Cole talk with Dr. Chris Stout, Vice President of Research and Data Analytics at ATI Physical therapy. The discussion centers around bone loss,  osteoporosis and calcium deficiency; the importance of proper life style, exercise and nutrition to minimize the effects of bone loss. Dr. Stout is also on faculty of the College of Medicine at the University of Illinois, Chicago. He has published over 35 books and been translated into eight languages. He founded a 501(c)(3) to work on international humanitarian projects, and subsequently has won five international humanitarian awards and four additional honorary doctorates.

Hip Dysplasia  in Young Female Athletes; The NBA Combine; Why we were Skinnier in the 80’s

Episode 17.12 with Hosts Steve Kashul and Dr. Brian Cole. Broadcasting on ESPN Chicago 1000 WMVP-AM Radio, Saturdays from 8:30 to 9:00 AM/c.

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Segment One (01:20): Dr. Joel Williams from Midwest Orthopaedics at Rush describes Hip Dysplasia, symptoms, treatment alternatives and who might be more prone to Image result for hip dysplasiahaving the condition.

Hip dysplasia, a condition where the hip socket doesn’t fully cover the ball portion of the femur, resulting in instability, is rising in young active women, who have probably had it since birth. Recent research shows that receiving care early is vital to a successful treatment experience for hip dysplasia patients.  Doing so may help patients delay or avoid having a total hip replacement (arthroplasty).

Dr. Joel C. Williams brings seven years of training and passion for complex fracture care, post-traumatic deformity, pelvis and acetabular surgery, and complex hip surgery to Rush University Medical Center.

Dr. Williams is a native of Michigan and graduated from the Michigan State University Honors Program. He then attended medical school at the Mount Sinai School of Medicine in New York. There, he was awarded a Doris Duke Clinical Research Fellowship and spent a year doing basic science research.

Dr. Williams’ surgical training began at the University of California, Davis Medical Center, where he completed his residency in orthopedic surgery. While a resident, he did a research fellowship and was awarded a grant from the Orthopaedic Trauma Association to investigate fracture healing. Additionally, he was awarded a traveling fellowship from the AO Trauma Foundation to study orthopedic traumatology in Chur, Switzerland with Dr. Cristoph Sommer. More…

Learn more about hip disorders at Hips for Life and download the Prevention Techniques Brochure

Hips for Life


Segment Two (12:26): Dr. Cole as head team physician for the Chicago Bulls discusses the various challenges related to the NBA Draft Combine and how they are dealt with in what is described as a complicated and chaotic process.

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Segment Three (17:09): Karen Malkin from Karen Malkin Health Counseling talks about why it’s harder for adults today to maintain the same weight as those 20 to 30 years ago did, even at the same levels of food intake and exercise; how to maintain a healthy microbiome/weight and how we can avoid the obesity epidemic.

  • People are exposed to more chemicals that might be weight-gain inducing. Pesticides, flame retardants, and the substances in food packaging might all be altering our hormonal processes and tweaking the way our bodies put on and maintain weight.
  • The use of prescription drugs has risen dramatically since the ‘70s and ‘80s. Prozac, the first blockbuster SSRI, came out in 1988. Antidepressants are now one of the most commonly prescribed drugs in the U.S., and many of them have been linked to weight gain.
  • The microbiomes of Americans might have somehow changed between the 1980s and now. It’s well known that some types of gut bacteria make a person more prone to weight gain and obesity.
Karen Malkin is certified as an Integrative Health Coach and Lifestyle Practitioner and a Certified Eating Psychology Coach. Karen has a private practice in Glencoe, Illinois.  She passionately serves on the Board of Directors for the Environmental Working Group, the Osher Center for Integrative Medicine, Spiral Sun Ventures and Gardeneer.