Physical Therapy for Hockey Injuries
Hockey is a high-intensity collision sport that requires athletes to skate a narrow contact surface (blade of the skate) on a low friction surface (ice) while moving in all planes of motion. Ice hockey demands strength, speed, flexibility, and endurance. The intensity of the sport can lead to a wide variety of injuries, such as concussions, shoulder separations, wrist fractures, MCL sprains, high ankle sprains, or FAI and hip adductor muscle strains. Physical therapy can not only help hockey players recover after injury through a targeted rehabilitation program, but also can help hockey players prepare for the hockey season and reduce the risk of injury through a personalized strength and conditioning program.
Physical Demands of Hockey
Hockey is a high-intensity collision sport that requires athletes to skate a narrow contact surface (the blade of the skate) on a low friction surface (ice) while moving in all planes of motion. Ice hockey demands strength, speed, flexibility, and endurance and involves three forwards, two defensemen, and one goaltender on the ice for an ice hockey team to be at full strength.
Each position places varying functional demands on each athlete; for example, defensemen must skate backward more than they skate forward, while forwards skate forward most often. Goaltenders can spend time relatively still and then be required to make quick movements involving large ranges of motion and flexibility. Stickhandling the puck also requires good hand-eye coordination, strength, and proprioception.
Common Hockey Injuries
Ice hockey is becoming an increasingly popular competitive sport. However, the high intensity of the sport and the high risk of collisions contributes to a variety of injuries.
Common hockey injuries include:
Concussion: A concussion is a traumatic brain injury that occurs due to a direct blow to the head or a whiplash movement that causes the brain to collide with interior wall of the skull. Concussions can occur in hockey when the head is hit by another player’s body part or the player is body-checked into the boards or into the ice.
Neck Injury: A neck sprain or strain can occur due to the high-force impact that can cause whiplash during player contact or if the player is crushed into the boards and the head twists unexpectedly.
Shoulder Injury: The most common shoulder injury in ice hockey is a separated shoulder from a fall or from getting smashed into the glass and boards. Most shoulder injuries occur at the glenohumeral and AC joints of the shoulder.
Elbow or Wrist Injury: Injury to the elbow or wrist can occur due to falling on the ice and putting the elbow or wrist and hand out to catch the fall, often spraining or breaking the wrist or injuring the elbow. Elbow injuries like bruising, a sprain, or bursitis can also develop from the strain and impact the elbows endure when players contact the boards, ice, or another player.
Back Injury: Hockey players can develop low back pain. This is because as players balance on ice skates while moving at full speed, they have to withstand other players’ blocks. Unnatural twisting can also cause a lot of torque on the body and strain back muscles.
Hip Injury: The skating motion that hockey requires places significant strain on the hip joints. Goalies are at a higher risk of a hip injury, particularly FAI, as they spend quite a bit of time in the “butterfly position,” moving in and out of hip internal rotation and flexion. The two most common hip injuries are FAI (femoroacetabular impingement) and hip adductor strains. Hip adductor muscle strains can occur due to the constant eccentric and concentric loading of the adductor muscles during forward skating stride.
Knee Injury: Knee injuries account for 15% of ice hockey injuries with MCL sprains being the most common knee injury. This is due to on-ice collisions that produce an excessive valgus force at the knee. Forwards are more likely to experience this injury as they skate forward and can eb body checked below their center of mass, creating a valgus load on the knee.
Ankle Injury: A twisted, sprained, or broken ankle can occur when skating at full speed, then coming to a sudden stop that strains the ankle. High ankle sprains are more commonly seen among hockey players.
Physical Therapy for Hockey Injuries
Physical therapy can not only help hockey players recover after injury through a targeted rehabilitation program, but also can help hockey players prepare for the hockey season and reduce the risk of injury through a personalized strength and conditioning program.
Physical therapy for hockey-related injuries can include:
Pain management using ice and heat to relieve pain and swelling
Stretching and range of motion exercises to address tight muscles and restore full range of movement in injured tissues and joints
Targeted strengthening exercises to strengthen muscles in the injured area and take stress off the injured joint. Strengthening exercises also can address muscular imbalances that may have contributed to injuries, such as strengthening the lower leg, ankle, and foot after an ankle sprain, targeting the quadriceps, hamstrings, and hip muscles after a knee injury, or focusing on strengthening the hip, gluteal, and leg muscles after a hip injury.
Core strengthening exercises to build a strong foundation for player’s movement and an efficient transfer of power from the lower to the upper extremity. A strong core helps stabilize the hips and trunk while engaging in multidirectional movements.
For a concussion, the therapist helps the player begin a safe progressive active rehabilitation with a graded sub-symptom aerobic exercise program, which helps the brain slowly adapt to the increased physiological demands of activity over time in a controlled environment with careful monitoring.
Sport-specific functional training including agility, coordination, and plyometric training to prepare for a return to the ice hockey rink
Return to sport program and testing, which involves objectively measuring the strength and function of the injured area and a progressive program to assess whether the athlete is ready for a return to sport and can withstand the physical demands of the sport after injury
A hockey-focused sports and conditioning program with a physical therapist can prepare the athlete’s body for the physical demands of hockey, minimize injury risk, and include:
Flexibility training: Hockey requires quick changes in direction while pushing off the skates rapidly. It is essential to have adequate flexibility throughout the lower body and trunk, as this allows for better mechanics when skating and more reach when goal tending. Good flexibility also decreases the likelihood of sustaining a muscle strain. The therapist implements specific stretching exercises to enhance flexibility, particularly in the hip and leg muscles.
Endurance training: Building endurance is critical in order to have the stamina to maintain proper form, biomechanics, speed, and agility throughout an entire hockey game. Muscle fatigue from low endurance can lower reaction times and decrease an athlete’s stability and protection around joints, heightening the risk of injury. Endurance training typically involves an aerobic exercise program.
Strength training: Hockey players should focus on full body strengthening, as this maximizes power output and speed and helps athletes have resilience to injury. Strengthening exercises include targeted resistance training of the shoulder muscle complex, core, hips, lower and upper legs, and foot and ankle complex.
Stability training: Sufficient shoulder, core, and pelvic stability helps hockey players maintain balance even when body checked at a high speed and allows for a powerful transfer of energy throughout the body. For example, the ability to shoot the puck involves transferring energy from the skates through the legs and trunk to the shoulder, requiring muscles to contract in a coordinated way to stabilize the joints and muscles, transfer the energy, and make a powerful shot.
Power training: Having power means being able to generate large amounts of force quickly, such as when skating powerfully and quickly, reaching across to block the puck as a goal tender, and driving the puck across the ice. The therapist may incorporate sprints on and off the ice and plyometric training to help athletes build explosive power.
Are you preparing for hockeyl season or experiencing an early season injury? Work with a physical therapist to regain strength, function, and mobility and prepare for a successful hockey season ahead!
