Hockey is an exhilarating game, known for its high-speed intensity, brilliantly crafted plays, and razor-sharp precision of movements. What sets hockey apart from other sports is its unique characteristics – skating on ice, using a stick to control the puck, and the level of contact permitted within the game.
Due to these characteristics, there are particular injuries that appear to be more common among hockey players. I will touch on some of the most common bodily injuries and ways to recognize and deal with each one.
(1) Shoulder Injury
Most shoulder injuries in hockey occur as a result of trauma, typically body-checking. In the physical therapy world, we look at the shoulder complex in relation to its varying joints.
At the glenohumeral joint (where the humerus meets the shoulder blade), this is where we find rotator cuff injuries and subluxation/dislocation.
People with injuries here often complain of pain when bringing the arm up, putting it behind their back, or lifting objects. The severity of injury at this joint is quite varied depending on what structures are injured and how they affect function. Generally, exercises that focus on stability at the shoulder are indicated – strengthening of rotator cuff muscles, as well as the shoulder blade muscles. Posture is almost always included in shoulder rehabilitation.
The acromioclavicular joint (where the collar bone meets the shoulder blade) is stabilized by three ligaments. When someone says that they have a “separated shoulder,” they are referring to these ligaments being torn. In hockey, a hit into the boards can cause a separation of the acromioclavicular joint. One way to check if the joint is damaged is to put your hand on the non-injured shoulder and lift your elbow to the sky.
If you have a localized pain on the top of the injured shoulder, it may indicate injury to the acromioclavicular joint. Exercises relating to shoulder blade stability are indicated. In extreme cases, surgery may be warranted.
(2) Hip Injury
The hip is one of the most susceptible joints for injury in hockey players. Usually these injuries occur without trauma.
Goalies who go into the butterfly position are at higher risk of femoral acetabular impingement (FAI). This is characterized by a pinching feeling in the groin when the thigh is rotated inwards, and lifted to roughly 90 degrees. FAI results in an abnormal growth of bone within the hip joint. The growth of bone can occur on the femur (cam lesion) or the acetabulum/pelvis (pincer lesion) or in combination. This is often a difficult injury to diagnose, but a couple of tests can provide suspicion of injury. These are called FABER and FADDIR tests. They involve bringing the hip into some degree of rotation and movement inward or outward. It should be noted that these tests can be painful with other hip conditions as well as FAI. FAI is typically treated with exercises to promote mobility in the hips, and surgery is indicated when the injury is severe.
Groin strains are the other common hip injury in hockey players. The hip adductor muscles that attach to the inner pelvis are responsible for bringing the leg towards the midline of the body (hip adduction). When a player kicks the leg out during skating, this creates a deep stretch to the adductor muscles, while they are simultaneously contracting to support the pelvis. This combination of stretching and contraction is what is referred to as eccentric muscular contraction. Eccentric contractions are very taxing on muscles, and in cases where a muscle is either weak or tight, it may be enough to damage the muscle. Typically, the injury is near the uppermost muscle attachment, which produces a pain in the groin region. Treatment includes proper stretching and progressive strengthening of the adductor muscles, prior to engaging in sport-specific drills.
(3) Knee Injury
The most common knee injury in hockey is a sprain to the medial collateral ligament (MCL). This ligament is on the inside of the knee. Injury to this ligament happens in hockey when a player is skating and has to turn sharply, or if another player falls on the outside of the knee. Pain is usually reproduced by bringing the knee towards the midline of the body in standing. Treatment for this injury includes range of motion exercises, progressive strengthening of the hip abductor muscles, and improving balance and stability.
(4) Foot and Ankle Injury
Unlike many other sports, lateral ankle sprains are not common in hockey, due to stability provided from the skate. What is more common, is what is known as a high ankle sprain. This occurs between the tibia and fibula, and can be fairly difficult to treat depending on the severity. Pain is often located higher on the ankle and aggravated by touch, squeezing the tibia and fibula together, and when the foot is forcefully brought up (ankle dorsiflexion). It is recommended to get an X-ray to rule out a fracture if a high ankle sprain is suspected. Treatment includes protection in the early stage, followed by progressive strengthening and mobility of the ankle, as well as balance and neuromuscular control.
Of course, this is only a very quick overview of some of the common injuries that happen in hockey. Regardless of what injury a player sustains, it is always recommended to get thoroughly evaluated by a doctor or physical therapist.
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