No matter what your age, if you play hockey — or any other sport — injuries are inevitable. However, according to Terry Kane, an orthopaedic physiotherapist who has worked with more than 500 Olympic and professional athletes, there are ways to minimize the potential for common on-ice injuries.
Having worked alongside some of the top orthopaedic surgeons and sports medicine physicians in Canada, Kane provides the following As to our Qs regarding the best injury prevention and rehab practices for hockey players today:
What are the most common sports injuries for hockey players?
In my experience, the most common injuries at every level of hockey are bruises and muscle strains in the hip and groin. Since these injuries resolve and heal on their own — without medical treatment and generally without missing ice time — they tend to be under-reported. Therefore, there are no hard statistics. Sprains (ligament injuries) that require time away from the game tend to be more frequently reported. Concussions are reported to be on the increase in hockey and football but, to some extent, this is inaccurate. Concussions have, unfortunately, been a part of hockey and football for decades. However, nowadays we’re better at recognizing them as serious, athletes are more comfortable acknowledging them and we’re keeping injured players out of the game. I wish I could say that concussions will be eliminated in hockey or football but, due to the nature of the game, I doubt this will ever happen.
What are the best ways to prevent injury in hockey?
Accidents can occur at any level of the game and in any environment. The best ways to prevent any injury in hockey are to:
- Play at the appropriate skill level and game speed.
- Have adequate individual skills that allow you to keep your head up at all times and not stare down at the puck.
- Be aware of where other players are on the ice at all times, and know how to get yourself into the proper position for a bodycheck.
- Wear proper-fitting and well-maintained equipment. There should be no exposed areas that could be hit with a puck, stick or skate.
- Be in top physical shape (speed, agility, endurance, strength) to withstand the demands of the game. I highly encourage all players at any level to skate in their equipment at least six to 10 times in the six weeks before tryouts. Trying to play yourself into shape during tryouts camp is a recipe for overuse injuries — most commonly groin strains. Since a groin strain can take months to fully heal, it can ruin an entire hockey season. But it is preventable by pre-tryout skating.
Special note for players with backyard rinks or who play drop-in stick and puck: Although the best way to prevent injury is to wear your full gear, it may not always be practical. At minimum, I recommend: helmet, elbow pads, shin pads and gloves.
If you do get injured, what are the best rehabilitation practices?
There is no answer that fits all. However, when it comes to any musculoskeletal injury, the most important thing to remember is that it needs time to heal properly. All injuries cause tissue damage and require time to heal biologically with repair tissue. Like glue setting, with each passing day the repair tissue gains tensile strength until it can take load again. Trying to do a task on immature repair tissue causes more damage, makes an injury worse and delays healing and returning to play. Many athletes either put pressure on themselves or feel pressure from others to return to the game before repair tissue at the site of injury has fully matured. This is why guidelines for the return to practice and play exist, to prevent recurrent injury. When a player suffers an injury, he or she needs to be medically cleared by a physician before returning to play.
Are there any other proactive exercises that can help minimize the potential for injury?
Yes, but these exercises need to be individualized. In some cases, weaker players will benefit from strength training, while stronger players would benefit from, perhaps, stretching or speed work. My best recommendation is to begin a conditioning program with a certified personal trainer four weeks after the end of the last season and to taper off all dryland training in the four weeks before tryouts. These last four weeks prior to tryouts should be for on-ice skating and light dryland conditioning, with the emphasis on speed, agility and quickness.
Do you recommend elite-level players, who are playing up to five times a week, see a sports medicine specialist on a regular basis?
Performance at any level of sport requires both mental and physical abilities. One of the biggest challenges facing elite-level players is overtraining and under-recovery. The culture of many sports struggles with “underperformers” or players who “aren’t playing to their potential.” Regrettably, these players are often viewed by coaches or others as “not trying,” when, in fact, the athlete is physically and mentally over-trained and exhausted. Not only are these players trying to excel at their sport, but they are also trying to do school work and perhaps a part-time job. Players who aren’t mentally and physically prepared or well rested for games make mental mistakes on the ice and expose themselves to risk of injury. Rather than the old-school practice of skating a team into the ground for underachieving, elite teams now engage conditioning coaches to help them decipher whether a given player needs conditioning or simply needs rest.
What advice do you have for parents and coaches of players age five to 18?
Accidents and injuries occur in all sports — even runners can slip and fall or overtrain. No hockey player wants to be injured and miss time, but it will happen. Given that soft tissue injuries and muscles can take months to fully heal, the most important advice for parents and coaches is to prevent any reinjury associated with a premature return to play. Regrettably, too often players assume that the absence of pain means they are fully healed, only to return too early, reinjure themselves and start the healing clock all over again. My best recommendation is to ask every player to be cleared medically by a physician or physiotherapist to return to unrestricted practice (can take body contact). Permission to return to practice is a medical decision, whereas a decision to return to play is a coaching decision based on the coach’s confidence that a player has regained their individual skills, is able to perform at top speed and has the psychological confidence to play. If a coach feels that a player lacks skating speed, can’t keep their head up or isn’t ready, the best decision is to hold them out until they are ready. In advance of talking to any player, coaches should always talk to parents so they have their input as well. Putting a player who can’t avoid a check because they lack speed or have their head down back into a game situation could expose them to suffering a concussion, which could be far more serious than the original injury. Unfortunately, this happens more often than we think. By default, no player should return to play a game unless they’ve participated in a minimum of two full-contact practices (including scrimmages) so a coach can make the best decision — with parents’ input — on behalf of the player’s health, first and foremost.
About Terry Kane, BPHE, BSC(PT)
Terry Kane has over 25 years of hands-on experience in assessing and designing rehabilitation programs for thousands of orthopaedic patients, including more than 500 Olympic and professional athletes. He has extensive experience in designing appropriate non-surgical treatment and rehab plans for patients to avoid surgery and chronic pain, and is a member of the Bone and Joint Health Strategic Clinical Network of Alberta Health Services. Terry has served as editorial peer reviewer for The Physician and Sportsmedicine, the Clinical Journal of Sports Medicine and Pain Research & Management. For more information, visit www.terrykane.ca.