Get Back on the Ice with Physical Therapy for Hockey Players
Physical Therapy for Hockey Players
In the last thirty years the sport of ice hockey has seen a sizable increase in participation at all levels of the sport. From youth hockey to the professional level, more players on the ice means more potential for injury. Whether it’s a nagging discomfort you’ve been noticing for a while or a sudden injury that’s just occurred, finding a physical therapist familiar with the demands of ice hockey is important. This article will discuss common injuries in hockey and how physical therapy can address these injuries to help you get back out onto the ice.
COMMON INJURIES IN ICE HOCKEY
If you’ve ever played ice hockey or enjoy spectating, you will notice that ice hockey differs from other sports in a few ways. Hockey is a collision sport and requires quick changes in direction and movement in all planes but unlike other contact sports, it is played on a frictionless surface while players balance on a very narrow contact surface (the blade).
Depending on the position you play you may spend more of your time skating backwards than forwards while some positions perform more crossover skating. Goaltenders may spend a period of time relatively still then be required to make quick movements that require large ranges of motion and flexibility. Furthermore, stickhandling the puck requires good hand eye coordination, strength, and proprioception (Wolfinger, Christopher and Davenport, Todd, 2016).
A review of hockey injuries in highschool and collegiate men’s and women’s hockey found that injuries were most common to the head/face, shoulder/clavicle, and hip/thigh/upper leg. Injury type ranged from concussion (most common), ligament sprains, muscle/tendon injuries and contusions (Lynall et al., 2018). Body checking accounts for a high percentage of injuries.
Depending on the type and severity of injury, loss of practice and play time can be a real concern. Having a proper rehabilitation plan and perhaps just as important, a comprehensive prehabilitation program, can help limit time spent recovering off the ice and reduce the likelihood of injuries overall.
WHAT DOES PHYSICAL THERAPY FOR HOCKEY LOOK LIKE?
Prehabilitation: Prehabilitation refers to participation in therapy based movements and exercises in order to avoid injury, decrease pain or to prepare for surgery. In the context of hockey, prehabilitation is intended to prepare the body for the physical demands of the sport to improve injury resilience and maximize the ability to recover from injury. Below are some of the components of prehabilitation for hockey players:
Flexibility: Hockey requires quick changes in direction and the ability to push off the skates quickly. Having adequate flexibility throughout the lower body and trunk will allow for improved mechanics while skating and more reach while tending the goal. It also decreases the likelihood of sustaining a muscle strain which can occur when the muscle is stretched beyond its level of flexibility.
Endurance: Muscle and cognitive fatigue can lower reaction times and decrease stability and protection around joints. Having the stamina to maintain proper form, biomechanics, speed, and agility through all four periods of a game can decrease one’s risk for injury and make playing the game more enjoyable.
Stability: Having sufficient shoulder, pelvic, and core stability not only makes one more resistant to being thrown off balance with a body check, but it allows for more powerful transfer of energy through the body. The ability to powerfully shoot the puck and transfer energy from the skates through the rest of the body to accelerate and decelerate is related in part to muscles contracting in a coordinated fashion to stabilize the bones and joints.
Strength: Full body strengthening is important to maximize power output and speed and to increase injury resilience during practice and competition. It is important to include shoulder strengthening exercises as shoulder and clavicle injuries are common in hockey.
Power: Skating powerfully, being able to reach across the crease as the puck comes flying at you, and driving the puck across the ice into the net requires the ability to generate large amounts of force quickly, also known as power.
Injury Rehabilitation: Despite great preparation, injuries can still occur and applying the right rehabilitation techniques is vital to ensuring full recovery of the injury, minimizing time spent off the ice, and reducing the likelihood of reinjury. Let’s take a look at how physical therapy can address some of the more common hockey injuries.
Concussion: Concussion is considered a functional brain injury. Its effects can not be seen in a CT Scan or an MRI but we know from more advanced imaging that it affects the brain’s ability to function which leads to the signs and symptoms we see after a concussion. Concussion is a serious condition and failure to allow full recovery before returning to full play can put one at risk for serious brain injury if they sustain another blow to the head.
Although most players will recover from a concussion within a couple of weeks, consulting with a physical therapist is important to both recognize signs of postconcussion syndrome, in which recovery is delayed, and also to guide the player through active recovery. A concussion does not necessarily require total rest but understanding what activities to limit and when to begin resuming activity is essential. If issues with dizziness, headaches, poor tolerance to higher intensity exercise, imbalance, or gaze stabilization persist, vestibular physical therapy can help a hockey player improve these symptoms.
Muscle strains: When a muscle is strained, you will typically experience pain in that specific muscle when it is contracted strongly or stretched. If the strain is moderate in severity you may also notice some localized stiffness, tenderness, and swelling in the area. You may also observe that the muscle feels weaker than usual. Finally, if it is severe and the muscle belly has separated from the tendon or all the fibers have torn, the range of motion of the joints at either end of the muscle may be either significantly reduced because of guarding or excessive because the torn muscle is no longer limiting it.
Recovery from a muscle strain depends on the severity but physical therapy can guide you through that process. Your physical therapist can advise you on how to manage pain and inflammation and protect the newly injured muscle while still performing exercise with uninjured body parts to limit overall deconditioning. Next you will be guided through a program of gradually strengthening and restoring flexibility to the muscle and then performing hockey-specific exercises to prepare the muscle for the demands of return to play.
Femoroacetabular Impingement (FAI): This condition in which there is bony overgrowth on the femoral head (ball) or acetabulum (socket) of the hip joint can lead to pain and pinching in the groin. It is most common in goaltenders who spend a lot of time in the “butterfly position” moving in and out of hip internal rotation and flexion which typically trigger symptoms of pain with this condition. When mild, this condition can often be treated conservatively with physical therapy but if a surgical approach is warranted then physical therapy will be needed after surgery to rehabilitate the hip and recover strength, mobility, and stability for return to play.
Ligament sprains: When a joint is moved beyond its normal range of motion it stresses and stretches the inelastic fibers of the ligaments surrounding it and can cause tearing (sprains). Because the primary function of ligaments is to provide passive stabilization to the area, loss of stability can range from mild to severe with a ligament sprain. Ligament injuries can occur in any joint but are common in the ankle, knee, shoulder and wrist. Your physical therapist can assess the joint to determine which ligaments are involved.
They will advise you on how to protect the ligament in the earliest phase to reduce pain and inflammation and protect healing tissues. In later phases of rehab you will focus on improving strength in the muscles that add stability to the joint and on motor control and proprioception to help protect the joint from future injury. When ready, your PT can advise you on how to begin hockey-specific drills and exercises to ease back into full participation.
CHOOSE PHYSICAL THERAPY
More time spent on the ice makes you a better hockey player and if hockey is what you love, then staying injury free is a priority. While you can’t prevent all injuries, physical therapy can help you identify the areas that make you more susceptible to injury so you can begin addressing them now. If you do find yourself injured, the physical therapists at Evolve will get you started right away on the road to recovery so you can get back on the ice.
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First we evaluate, then we heal, then we strengthen our clients so they can reach their goals, feel better, and live happier lives. We do so by utilizing a range of core techniques and specialized treatments to reduce pain, improve mobility, enhance physical strength and deal with the underlying issues, not just the pain itself.
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