Hockey is an exciting, physical sport that has become increasingly popular in Texas. Currently, Texas has more professional hockey teams than any other state in the country, a whopping 23 total. More hockey playing means more hockey injuries, many of which are unique to the sport. That’s where Dr. Mark Muller comes in. He is an orthopedic surgeon at North Central Surgery Center and the WB Carrell Clinic. He specializes in orthopedic sports medicine and arthroscopic surgery of the knee, hip, and shoulder and is a team physician for the Dallas Cowboys. He also served as a team physician for the Dallas Stars from 2008-2012. We asked him questions about hockey injuries, including the most common types and ways to treat them.
Q:What are the most common hockey injuries you see in your patients?
A: The most common injuries in hockey are contusions, sprains, and strains.
Contusions
Contusions are direct-impact injuries resulting from either running into the boards or being hit with a stick (slashing) or puck. Contusions usually occur in areas not covered with padding. Smaller, more superficial contusions cause simple bruising and localized tenderness. Deeper contusions can affect performance, causing pain and swelling within the deeper muscle layers. Proper-fitting equipment and the use of additional padding can decrease the risk of sustaining contusions. These injuries are generally treated with ice and compression to reduce the pain and swelling. Activity modification and rest may be required if performance is affected.
Sprains
Sprains are injuries to the ligaments that stabilize the joints in our bodies. Knee and shoulder sprains are common injuries in hockey. Medial collateral ligament (MCL) sprains are the most common knee injury. MCL sprains occur when the knee is bent inward and can result from the skate getting caught in a rut or when there is direct contact to the outer side of the knee. These injuries cause pain on the inner side of the knee and can result in knee instability. MCL injuries are usually treated with a brace. More significant injuries can result in a tear of the anterior cruciate ligament (ACL) or a tear of the cartilage (meniscus) in the knee. These injuries usually require arthroscopic surgery. Significant knee sprains should be evaluated by a physician with experience in orthopedic sports medicine.
Shoulder sprains are also common in hockey. The most common shoulder sprain is the “separated shoulder” or acromioclavicular sprain. The acromioclavicular (AC) joint connects the collarbone (clavicle) and the top of the shoulder blade (acromion). This injury occurs when there is direct contact between the top of the shoulder and another player, the boards, or the ice. AC sprains are generally treated with rest, ice, sling support, and early rehabilitation to maintain shoulder motion and strength. Severe AC sprains may require surgical stabilization. Proper-fitting shoulder pads can help prevent AC sprains. Hockey players should also be taught proper checking techniques to prevent injuries to the AC joint. Shoulder dislocations and subluxations (partial dislocations) are another type of shoulder sprain that involves injury to the ligaments that connect the shoulder blade to upper arm. These injuries can result in recurrent shoulder instability, especially in younger hockey players. Shoulder dislocations and subluxations (partial dislocations) should be evaluated by a physician with experience in orthopedic sports medicine.
Strains
Strains are injuries to the muscles and tendons that cross over a joint and help those joints move. Hip flexor and groin strains are common in hockey because of the forces imparted on the hip flexors and groin muscles during the skating stride. Proper hip and groin stretching before and after skating can help prevent these injuries. Off-season strengthening and flexibility programs can also be very helpful to prevent recurrent strains in the hip and groin.
Q:What are the most common long-term injuries?
A: Chronic back pain is a common complaint, especially in older hockey athletes. The skating stride involves a forward flexed lower back posture that puts stress on the muscles and joints in the lower back. In addition, repetitive rotation of the lower back while skating and shooting the puck imparts additional stress on these same muscles and joints. Chronic injuries to the lumbar discs, vertebral facet joints, and paraspinal muscles are common in hockey. Most of these injuries can be prevented with proper core strengthening and hip and lumbar flexibility programs.
Q:What is the most important step to take after a concussion?
A: All hockey athletes who have sustained a head injury or concussion should be cleared by a licensed healthcare professional. Concussions generally resolve with rest and activity modification. Concussions present with a wide variety of symptoms, including headache, difficulty concentrating, memory loss, imbalance, nausea, vomiting, and visual changes. Avoidance of all activities that aggravate these symptoms is a critical component in the treatment of concussions. Rest, both mental and physical, will be required. In younger athletes, avoidance of external stimuli such as video games may be required to allow complete resolution of symptoms. Severe concussions may require time away from school to provide adequate mental rest. Athletes should be free from all symptoms while at rest prior to returning to physical activity. After symptoms have resolved, initial exercise generally involves a simple cardiovascular test (pushups, riding a stationary bike, etc.). If symptoms are reproduced with this activity, then further rest is needed. Hockey athletes should be able to participate in full noncontact practices without reproduction of any concussion symptoms prior to returning to full-contact practices or games. Again, a licensed healthcare professional should evaluate and clear a hockey athlete prior to returning to play.
Q:How often should hockey players come in for a checkup?
A: Annual pre-participation medical examination is required for all high school hockey athletes. Annual examination is recommended for other hockey athletes as well. Older athletes may require an EKG, echocardiogram, or other cardiac stress test as part of their medical clearance. Maintenance of general athletic conditioning is critical to stay healthy and avoid injuries while playing hockey. Flexibility, core strength, and cardiovascular fitness are all critical components of general athletic conditioning. A certified athletic trainer can be helpful in identifying and addressing deficiencies in flexibility, strength, and fitness prior to participation in hockey.
