It is no doubt that hockey is one of North Americas greatest sports, enjoyed by millions and played by thousands of youths. Despite the growth and popularity of the sport, there is a great deal of injuries that occur. It is important to make parents and the public aware of the importance in understanding that injuries can occur among youth populations in any level of the sport. It is important for parents to understand that injuries do occur, and they should not be taken lightly. Proper evaluation by health care professionals, especially those that are familiar with the sport, is necessary for safe and healthy development, and return to sport. This brief overview outlines the type of injuries to watch out for among youth and hockey.
With a large physical component in professional hockey, body checking is an important element in succeeding in the sport. However, many organizations do not have a good consensus on when to allow young athletes to start body checking. A recent study showed 45% of injuries involving body checking occurred among young hockey athletes aged 9-16. Personally, I believe that body checking should begin at the age of 15, which is inline with the American Pediatric Association. This is important because at this age, the young athlete should have begun undergoing a hockey specific strength and conditioning program that conditions their body for the demand of the game as they mature. While no studies to my knowledge show the reduction injuries from body checking with a strength and conditioning program implemented, one can understand that this addition to training can help the athlete gain a stronger and more agile physique to withstand the demand of body checking and the injuries that could come with the sport. Some of the injuries that are common with body checking involve shoulder injuries and concussions. In this blog entry, we will focus on the lower extremity injuries:
Hip and Pelvis
The hip and groin are 0ne of the most common areas of injuries for a hockey player. Among youths, about 9% of injuries occur within the hip joint area. These types of injuries can occur from skating and body contact.
Adductor Muscle Strain: A common injury also known as a “groin pull” usually resulting from the muscle straining groin muscle after a forceful eccentric component of skating (strides). This type of injury can be debilitating and result in more missed games and practice if left undisclosed and untreated. The player often complains of a sharp/intense pain in the groin during skating, with localized tenderness in the groin.
Avulsion/Apophyseal Injuries: In addition to muscle strains, there can be injuries to the cartilage and bones themselves. As you may be aware, tendons attach on to bony regions, and with explosive movement and high intensity training, these areas of attachment are subject to injury. The player will often complain of sharp pain with stretching, and usual present with localized tenderness.
Hip contusions: Contusions are also a common injury, more present around the contours of the pelvic bone. These are termed hip pointer injuries and are self-limiting requiring rest and often a medical specialist to rule out any potential fractures. The player would complain of pain on touch and with sneezing and coughing, and slight twist movements.
Athletic pubalgia is another injury, more serious, and it is important to get treatment almost immediately as the severity of the injury, when left unattended, it can result in invasive treatment options such as surgery. It is caused by a soft tissue tear of the posterior inguinal region that results in nerve entrapments and pain that radiates to the lower back, scrotum and hip and is caused by a motion of a slap shot. This style of injury is likely to have surgical repair if the pain level is moderate to severe. The player would complain of similar pain as a groin pull, but a medical examination would help determine the diagnosis.
Femoral acetabular impingement syndrome: As I have stated in my previous blog post, FAI is an impingement of the soft tissue structures in the hip. This is usually caused by the biomechanics of skating if the hip angles are too narrow or too wide and the muscular control of the hips are not conditioned properly. This is a commonly diagnosed hip injury found in all levels of play. The player often has reduced range, pinch like pain in the hip and sharp pain with sudden motions.
MCL Sprain/Tear/ Fracture: Despite being a strong ligament in the body, the medial collateral ligament (MCL) is subject to much stress in hockey, especially after contact that results in a valgus force (knees cave inwards). A common time frame to reducing this injury is usually between 4-8 weeks depending on the grade of the injury. In young athletes, there are growth centers that are sensitive to this type of injury and must be assessed for various forms of fractures.
Tibialis Anterior Tendinosis: This is colloquially named “Skate Bite”. This often occurs when the tongue of the skate is too stiff and rubs against the tibialis tendon along the anterior portion of the leg and ankle. The tendon is subject to inflammation due to chronic irritation and thus results in swelling and pain. Rest, ice, and over the counter medications (Rx from a family doctor) can be helpful to reducing the pain and control the swelling. It is important to augment the skate by adding a padding to help reduce pain, and to break-in the tongue of the skate to reduce stiffness.
High Ankle Sprain: While less common, due to the nature of changing speeds and movement, the ankle can be subject to a syndesmotic sprain (separation of the two bones that make up the leg) resulting in pain. This injury, often played through, can result in many games lost due to lack of treatment. Players would often complain of pain with walking and weight bearing.
In conclusion, lower extremity injuries do occur among hockey players at any level. However, among youth populations, it is important to be sensitive to the fact that injuries do occur, and they should not be “brushed off”, or “sucked up”. It is important for parents and coaches, alike, to know that these injuries require immediate action and advice from a medical professional. It is important to always follow up with your health professional to mitigate injury severity and allow for access of the proper health care for safe return to sport.
Dr. Nourus Yacoub, DC
Medical Director and Chiropractor
Royal Chiropractic and Sports Injury Clinic
Popkin et al. Evaluation, management and prevention of lower extremity youth ice hockey injuries. Open Access Journal of Sports Medicine. 2016:7(167-176).