Shoulder complex injuries are a burden in hockey, costing the athlete many missed games and practices. It accounts for about 18% of hockey injuries, with more than 3/4 of injuries resulting from player-player contact, and the growing number of occurrences occurring at among youth populations (Emery, 2016). The NHL reports over $306,000 USD salary lost per season due to shoulder complex injuries (Donaldson, 2014).. Shoulder complex injuries include injuries that include the glenomhumeral joint (GH Joint), Acromioclavicular joint (AC Joint), and surrounding soft tissue structures. It is understood that 45% of all injuries (upper and lower body) do occur with body checking (Emery, 2006), hence it is important to prepare the young athlete and the rehabilitated athlete for this during game and practice situations.
GH Joint Injuries and AC Joint Injuries
The GH joint is subject to a contact injury, as in a contact with another player or with the rink boards during a body check. AC joint injuries occur more commonly with player-board contact following body checks. The return to play protocol for a shoulder injury, like a dislocation or subluxation, varies on the severity of the injury and some will have fractures, soft tissue injuries, tendon injuries, or a combination. After such an injury, it is important to have the athlete no participate in skating until the end-phase of the rehabilitation. This is precautionary to allow for unpredicted falls, checks and sudden movements that may aggravate the healing shoulder. An important alternative to skating is what is commonly used in off-season, dryland! The athlete should be doing specific rehabilitation for the shoulder that is also mixed with clinical rehabilitation involving range of motion exercises, strength, power and endurance as well as neuromuscular re-training (Wolfinger 2016). The athlete should then begin a sport-specific program that involves stick handling, shooting, and skating for progressing the athlete back to their sport as quickly and safely as possible.
Prevention of Shoulder Complex Injuries
The athlete with a suspected shoulder complex injury should be screened for their shoulder range of motion, thoracic spine mobility, motor control, soft tissue mobility, and any imbalance with the neuromuscular system (Boenisch , 2001). There are many different shoulder and rotator cuff strengthening programs for ice hockey participants to decrease the prevalence of shoulder complex injuries and to rehab the shoulder.
All hockey athletes, at all levels, should always have a appropriate conditioning and screening program that addresses shoulder and upper body endurance, strength, power and neuromuscular activation both pre-post injury, and especially before returning back to play.
Dr. Nourus Yacoub, DC
Medical Director and Chiropractor
Royal Chiropractic and Sports Injury Clinic
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Emery CA, Meeuwisse WH. Injury rates, risk factors, and mechanisms of injury in minor hockey. Am J. Sports Med. 2006;34(12):1960-9.
Wolfinger CR and Davenport TE, Physical therapy management of ice hockey athletes: from the rink to the clinic and back. The International Journal of Sports Physical Therapy.(2016) 11(3):482-495.