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.

What’s in your tap water? – filter for optimal health!

By Karen Malkin – Karen Malkin Health Counselsing

Water is the driving force of all nature.” — Leonardo DaVinci

Did you know that nearly all the major systems in your body depend on water?

Water moistens sensitive tissues, lubricates joints, protects organs, regulates body temperature, helps dissolve minerals to make them accessible to your body, carries nutrients and oxygen to cells and lessens the burden on the kidney and liver by flushing out waste. That’s why it’s so important to stay hydrated! As a reminder, your daily requirement is half your body weight in ounces.

Your Water Source
It’s tempting to drink straight from your tap, but is the water safe? To make it easier to understand exactly what’s in your water, the Environmental Working Group (EWG) has pulled together a comprehensive database of drinking water quality reports by zip code. Click here to find the results for your area.

According to the EWG’s study, “The vast majority of the nation’s drinking water supplies get a passing grade from federal and state regulatory agencies. However, many of the 250-plus contaminants detected through water sampling and testing are at levels that are perfectly legal under the Safe Drinking Water Act or state regulations, but well above levels authoritative scientific studies have found to pose health risks.”(1) This is where we can take action.

Greater Chicago Water Contaminants

For our greater Chicago area (I pulled the results for the north shore areas) and 10 contaminants were shown to be present at levels higher than what’s considered safe.

  • Arsenic

  • Bromodichloromethane

  • Chloroform

  • Chromium (hexavalent)

  • Dibromochloromethane

  • Dichloroacetic acid

  • Radiological contaminants

  • Total trihalomethanes (TTHMs)

  • Trichloroacetic acid

  • Hormones

Of these contaminants, I’d like to focus on chromium-6 or hexavalent chromium. It’s naturally occurring, but mostly a chemical byproduct of industry. Made notorious by the film “Erin Brockovich,” hexavalent chromium is unregulated under the Safe Drinking Water Act. California state scientists have established a level at which this chemical poses a negligible risk of cancer for people who drink it daily for a lifetime.(2) It has been detected in levels HIGHER than that in drinking water supplies for more than 250 million Americans in all 50 states. This is alarming.

Fortunately, there are ways to clean this up so you can safeguard your health. As part of the study, the EWG has provided suggestions for specific filters—across all price ranges from simple pitches to whole-home systems—that pull out specific contaminants found in your tap water.

Here are a few filter options to pull out hexavalent chromium from your tap water.


PITCHERZeroWater 8-Cup Stainless Steel Pitcher

  • Uses ion exchange and granular activated carbon

  • Only pitcher certified by NSF to reduce both lead and chromium

  • BPA free

  • TDS (total dissolved solids) meter that provides a digital reading so you know when it is time to change your filter

DISPENSERZeroWater 23-Cup Dispenser 

  • Uses ion exchange and granular activated carbon

  • Only pitcher certified by NSF to reduce both lead and chromium

  • BPA free

  • TDS (total dissolved solids) meter that provides a digital reading so you know when it is time to change your filter

  • One-handed “push to dispense” spout to fill any bottle or cup

PLUMBED-IN, SEPARATE TAPMicroline Reverse Osmosis System TFC-435

  • Uses reverse osmosis and granular activated carbon

  • Up to 35 gallons per day

  • NSF Standard 58 Certified System

  • 4-stage TFC (thin film composite) performance

  • Comes with 1 free set of replacement filters

PLUMBED IN: Whether or not your water is harmful of helpful depends on what’s in it. Distillers and reverse osmosis systems come the closest to removing most contaminants. If you are on public water, call your water provider and ask for the Annual Consumer Confidence Report which will contain a list of regulated contaminants in your water.

For public/municipal water supplies, pay attention to what is intentionally put into your water to disinfect it for you. Numerous contaminants naturally occur in well water. If you are on a well, it’s important to have your water independently tested for contaminants. Know the contaminants in your specific water, and find filters that remove them. Download Environmental Working Group’s water filter guide here.

For a list of 70+ more filters that take out hexavalent chromium, click here.

Karen


MORE NEWS
Karen’s Corner 

SAVE THE DATE: Please join me me on Wednesday, April 18th at The Four Seasons Chicago! Keynote, Tieraona-Low Don, MD, will speak on her latest book “Life is Your best Medicine”! I am chairing this event and created an anti-inflammatory menu with the chef. The food will be amazing! Click here for tickets or reach out to me directly by replying to this e-mail. Join me in supporting my mission to help change the way we practice medicine by supporting the Osher Center for Integrative Medicine at Northwestern Medicine.

MUST SEE DOCUMENTARY: I sponsored a documentary film at Sundance Film Festival, The Devil We Know, unraveling one of the biggest environmental scandals of our time, a group of citizens in West Virginia take on a powerful corporation after they discover it has knowingly been dumping a toxic chemical- PFOA- into the water supply. PFOA is found in the blood of 99.7% of Americans and used to make Teflon, Gortex, Scotchguard, and many other products.

Are you looking to reduce your toxic load with a metabolism re-set this Spring? Sign up for one of my 14 Day Transformation programs here:

5 Ways Movement Enhances A Parkinson’s Disease Diagnosis

By Erica Hornthal, MA, LCPC, BC-DMT; CEO Chicago Dance Therapy

Related image

I’m not here to tell you why exercise or a certain type of activity like dance or yoga, is beneficial.  Anyone can type “PD and exercise” into Google and read one of 63 million results. What I would like to share are the psychosocial implications that arise from engaging in movement.  How movement enhances our emotional, social, and cognitive well-being is imperative following a diagnosis of Parkinson’s disease.

Movement, our earliest form of communication, seems to be taken for granted only until we see it deteriorate or are faced with a degenerative disease that reminds us that our movements are so much more.  They are a connection to ourselves and our environment. Engaging in movement is not just about maintaining our physicality, but about preserving our existence.


Assists in symptom management: Research has shown that movement can help manage problems with gait, balance, tremors, flexibility, and coordination.  Improved mobility has been shown to decrease the risk of falling as well as other complications from PD. This often occurs because the brain is learning to use dopamine more efficiently.  

Promotes self-awareness and identity: Every person has a different way of moving and certain affinities toward movement.  It is those differences that promote a capacity for introspection and the ability to stand out as an individual.  Muscle memory even has the ability to tap into memories stored in the brain. Movement has the ability to retain our memories and create new ones.  

Maintains a sense of control: Connection to our breath, the most primitive form of movement, enables us to control our pulse rate, circulation, and even our thoughts.  This is so important for when we feel like things are out of our control or when our body is not functioning the way we would like, we have the power through our own breath to take back a sense of control.  

Builds psychological resilience: Movement has the ability to actually increase our adaptability to stress and adversity.  Reinforcing our own connection to the body empowers our psyche and encourages inner core strength.  This core I’m referring to isn’t your abdominals, but rather your identity. Connecting to the muscles in your chest, torso, and pelvis tap into your belief system, identity formation, and personality.

Maintains social connections: From early on in human existence, there is documentation of celebration and rejoicing through song and movement.  Movement has the ability to connect us with others without verbal communication. We can join in someone’s experience just by witnessing and empathically embracing their body language.


These 5 ways in which movement enhances our mind body connection are just the tip of the iceberg.  Movement is more than just exercise and physical fitness. Movement is body language, expression, and creativity.  Movement is an innate part of being human and just because that ability changes when diagnosed with PD, that does not mean that we should give up all that it entails.  It is even more imperative that we engage in movement to preserve that very part of who we.

Erica Hornthal is a licensed professional clinical counselor and board certified dance/movement therapist. She received her MA in Dance/Movement Therapy and Counseling from Columbia College Chicago and her BS in psychology from University of Illinois Champaign-Urbana.  

Erica is the founder and president of North Shore Dance Therapy and Chicago Dance Therapy. As a psychotherapist in private practice, Erica specializes in working with older adults who are diagnosed with dementia and movement disorders. Her work has been highlighted nationally in Social Work Magazine, Natural Awakenings, and locally in the Chicago Tribune as well as on WCIU and WGN.  


Parkinson’s Awareness Month: #StartAConversation

Every April, the Parkinson’s Foundation engages the global Parkinson’s community to support Parkinson’s Awareness Month. When we raise awareness about Parkinson’s and how the Foundation helps make lives better for people with PD, we can do more together to improve care and advance research toward a cure.

Help For Elbow Injuries In Pitchers? A Prevention Program Offers Hope

By Dev Mishra, M.D., President, Sideline Sports Doc, Clinical Assistant Professor of Orthopedic Surgery, Stanford University

Key Points:

  • Overuse injuries to the elbow are common in young baseball players, and prevention programs are needed to reduce injury risk
  • A recently published scientific study highlighted the potential benefit of a stretching program called the Yokohama Baseball-9, showing a significant reduction in elbow injuries for players who used the program compared to those who didn’t
  • The program has the potential to be a useful tool in reducing numbers of elbow injuries for young baseball players

I’m a big believer in prevention programs for sports injury risk reduction and this week we’ll discuss a program to reduce elbow injury risk in baseball.

I’ve written before about the usefulness of the 11+ warmup program for lower extremity risk reduction in soccer. That program is highly effective. Prevention programs are great in theory but actually proving the usefulness can be difficult. What are required are often lengthy scientific studies with large numbers of individuals. Those types of studies have been done with the 11+ but are lacking for elbow injury prevention programs in baseball. But a recently published study from Japan offers some hope.

The study authors devised the Yokohama Baseball-9 (YB9) program, which consists of 9 flexibility exercises focused on the wrist, elbow, shoulder, and hips.

There were 275 players age 8 to 11 divided into a non-YB9 group and a YB9 group. Players were asked to complete the program at least once a week.

At 1-year, the YB9 exercise group had significantly lower rates of elbow injury and significantly better total range of motion at the shoulder. In a statistical analysis, increased shoulder total rotation, increased nondominant hip internal rotation and improved spine posture predicted lower rates of elbow injury.

This is a good study but there are some weaknesses. 28% of the original group was excluded due to prior shoulder or elbow pain and an additional 15% were lost to follow up. And it is a relatively small number of players who participated.

We need more studies like this so I hope it can be repeated by others, and with larger numbers of players. The fact that 28% of the young players in the original group of potential players were excluded because they already had pain in pretty alarming, and good evidence that we need some solutions to the problem of overuse injuries in baseball pitchers.Logo

Overall, the study is encouraging and provides an interesting new potential avenue for injury prevention.

The Importance of Strengthening the Gymnast’s Elbow

By Tara Hackney, PT, DPT, OCS, KTTP for Atletico Physical Therapy

strengthening gymnasts elbowGymnastics offers a unique perspective, even allowing some athletes to see the world upside down!

Very few sports involve supporting the entire body weight with the arms like gymnastics. Due to these special considerations, gymnasts are more prone to certain injuries, such as Osteochondritis Dissecans of the elbow (OCD), and should take care to strengthen the entire arm to decrease injury risk.

What is OCD Elbow?

Osteochondritis Dissecans (OCD) lesions can be found in the elbows of adolescent athletes. The exact cause of OCD in the elbow is unknown, but repetitive microtrauma and decreased blood flow to the subchondral bone are believed to play a role. As the underlying bone weakens, a segment of the articular cartilage separates from the subchondral bone, forming a lesion. OCD lesions in gymnasts may be caused by repetitive weight bearing on the hands with the elbow in extension.

Presentation of elbow OCD is very vague. A patient can have pain, tenderness and swelling over the lateral aspect of the elbow. There may be limitation in how straight the elbow can go and there may be locking or catching if the injury has progressed. However, tendinitis of the elbow can have a similar presentation. More often OCD is suspected in specific patient populations including pre-teen and teenage gymnasts as well as young baseball pitchers with elbow pain. Diagnosis is through imaging such as x-ray or MRI.

Treatment for OCD Elbow

Non-operative treatment for elbow OCD consists of rest and sports restriction. For a gymnast that means no weight bearing on arms and no hanging from bars or rings as the latter puts traction stress through the elbow. Muscle strengthening exercises and possibly a short period of immobilization are also usually a part of treatment.

There are some cases where the lesion is unstable and surgery is the best option. After surgery, physical therapy is performed to reduce pain, swelling and restore range of motion. Resistance strengthening is also incorporated into the rehabilitation after bone healing has occurred, usually around 8 weeks after surgery.

What Can Athletes Do While Resting Their Elbow?

If a gymnast has been diagnosed with an OCD lesion, they are not allowed to do any weight bearing on the arm, which includes performing skills on the bars. So what can the gymnast do as they allow their elbow to heal? Core strengthening is one option, as core strength is vital to a gymnast and is important during all events. Leg strengthening can also be performed while adhering to the restrictions on the elbow. An overall conditioning program can be designed for the athlete that will incorporate cardio, core strengthening, leg strengthening, shoulder and wrist strengthening, and flexibility stretching. Staying active and in shape is vital to the gymnast during this time to assist in returning to the sport when the elbow restrictions are lifted.

Arm Strengthening for Gymnasts

The elbow is the middle joint of the arm with the shoulder and wrist on either side. While the gymnast’s elbow is healing, it is important to strengthen both of the surrounding joints to provide extra stability for the arm for when return to weight bearing is allowed. Prior to initiating any activities, ensure the gymnasts’ physician has cleared them for return to these exercises.

            Shoulder strengthening examples:

  • Resistance band exercises including rows, shoulder extension, diagonals, internal/external rotation
  • Sidelying shoulder external rotation
  • Tricep extension with band or hand weight
  • Bicep curls with band or hand weight
  • Prone I, T, Y exercises – exercises can be performed using a swiss ball for added core activation, hand weights can be added for resistance
  • Gradual return to weight bearing exercises, like push-ups, planks and handstands, can be added when the athlete is cleared from restrictions

            Wrist strengthening examples:

  • Wrist curls in both directions with a weight or resistance band
  • Gripping exercises for the hands
  • Wrist rotation exercises, such as hand weight rolling
  • Supination/Pronation with a hand weight

Arm Stretching for Gymnasts

  • Wrist flexor stretch
  • Wrist extensor stretch
  • Cross body shoulder stretch
  • Tricep stretch
  • Shoulder flexion stretch on foam roller, wall, or mats
  • Shoulder circles – lie on your side on the floor and draw a circle on the floor with your top arm by rotating your upper body
  • Doorway stretch

Strengthening the Upper Body

Gymnasts have special considerations due to the nature of their sport with weight bearing on the arms. This can lead to injuries of the elbow such as OCD lesions. Strengthening of the entire upper body, including shoulder and wrists, should be incorporated into a conditioning program for both healthy gymnasts and gymnasts recovering from an elbow injury.

For more information, contact an Athletico clinic close to you for a complimentary injury screening.

Schedule a Complimentary Injury Screen