Hockey Training Programs
Certain sports require intraoral devices that can cause malocclusion or TMJ stress. Ice hockey, football, and boxing, for example, use oral mouthguards that protect the teeth. These devices should be examined to ensure that they do not alter occlusion or load the temporomandibular joints. Chin straps should also be examined to ensure that they are not too tight and do not compress the temporomandibular joints.
Second-impact syndrome is a rare but potentially fatal cumulative injury that occurs when an athlete, having not yet recovered from an acute brain injury, sustains a second injury before the symptoms associated with the first injury have resolved. This syndrome dramatizes the extreme vulnerability of the mildly injured brain. The true incidence of SIS is actually unknown. The National Center for Catastrophic Sports Injury Research reported 35 probable cases during the time period of 1980 through 1993 and 17 of these were confirmed with necropsy or surgery and MRI findings. The SIS has been reported in football, boxing, ice hockey, and downhill skiing.
CTBI has been a disorder more commonly reported among boxers however, this condition can also be encountered in football, ice hockey, soccer, rugby, and potentially any sport associated with recurrent concussion. The frequency of CTBI in sports is largely unknown. It has been estimated that the prevalence of CTBI among retired professional boxers is 17 however, the incidence or prevalence in football, ice hockey, soccer, rugby and other contact collision sports is unknown. Cumulative injury is an extremely important concept in athletic concussion. There can be significant morbidity associated with more than one concussive episode. After a second concussion, the postconcussion syndrome is more pronounced. Multiple concussions may affect personality, academic performance, and the ability to return to competition. However, long-term effects can be even more devastating.
Excessive cervical forward bending (hyperflexion) can cause a sprain, strain, subluxation, dislocation, or fracture. Protective muscle spasm and associated pain make it difficult to determine which of the cervical structures is injured. The mechanism is not actually a pure hyperflexion but a combination of compression and flexion or flexion and rotation. Major stress occurs at C5-C6 level where the mobile cervical vertebrae join the less mobile vertebrae of C7 and Tl. This forward bending mechanism of injury occurs frequently in sports such as diving (into shallow water), trampolining, rugby, football, and ice hockey.
In many sports there are activities which are forceful and explosive, e.g. high jumping, hiding in boxing and turning in ice hockey. The power output during such activities is related to the strength of the muscles involved in the movements. Thus, it is beneficial for an athlete in such sports to have a high level of muscular strength, which can be obtained by strength training.
Co-ordination and muscle strength and should be prescribed to already fit individuals, for example soccer or rugby players, but cannot be recommended for those with poor balance and co-ordination. For example, for those with shin splints or who are recovering from knee surgery, as an alternative to bicycling and running, roller-skating is very efficient endurance training to develop quadriceps muscle strength. For ice-hockey players, roller-skating is a natural way of exercising during pre-season training. Both skateboarding and wind-surfing are excellent balance exercises for different seasons for injured martial arts athletes and gymnasts. All these sports should preferably be performed in controlled environments, with instructors.
Ice hockey skating Table 3.1.3 shows the incidence rates for some team sports commonly played in Scandinavia. Although there is a limitation to the number of studies available in some sports, the trend seems relatively clear. Ice hockey is the game with the highest rate of injuries by far, in most studies 50-80 injuries per 1000 player- hours during games. Ice hockey is followed by soccer with a match injury incidence of i8-35 per i000 player-hours. There is only one study available from European team handball, showing an incidence slightly lower than soccer, and volleyball appears to have the lowest injury rate of the most popular Scandinavian team sports. There is no prospective study available from Scandinavian basketball, but other studies have shown rates just slightly higher than volleyball 18 21 . Table 3.1.3 also shows other interesting trends. It appears that within a certain sport, competing at a high level increases sports injury risk and more injuries are sustained during...
An estimated 300,000 concussions occur each year from sports-related activity (Centers for Disease Control and Prevention CDC , 1997). In high school football, there are 40,000 concussions per year, for a 3 to 5 incidence (Powell and Barber-Foss, 1999). High-risk sports include contact and collision sports such as football, ice hockey, rugby, wrestling, and to a lesser extent, soccer and basketball. Women may be more prone to concussion in some sports (Tierney et al., 2005), for unclear reasons, with further research needed. Younger players also may be more prone to concussion because of less developed neck muscles and the higher relative weight of the head compared with the rest of the body. In addition, children may sustain more serious concussions because of their immature nervous system.
Injury to the spinal cord resulting in temporary or permanent neurologic injury is a rare but potentially catastrophic event during sports competition. Cervical spine trauma is most common in contact and collision sports such as American football, rugby, ice hockey, gymnastics, skiing, wrestling, and diving (Cantu and Mueller, 1999 Carvell et al., 1983 Tator and Edmonds, 1984 Wu and Lewis, 1985). Cervical spinal cord injuries are the most common catastrophic injury in American football and the second leading cause of death attributable to football. The National Center for Catastrophic Sports Injury Research reported that the incidence of cervical spinal cord injury in American football between 1977 and 2001 was 0.52, 1.55, and 14 per 100,000 participants in high school, college, and professional football, respectively (Cantu and Mueller, 2003).
During a sudden change of direction while running, and quick starts and stops. Factors such as weakness or tightness of the adductor muscles can predispose an athlete to a groin strain. This injury is commonly seen in soccer players as well as football, ice hockey, basketball, tennis, and baseball players.
On the other hand, aggressive behaviour which was not a punishable offence also showed significant correlations with androgens in men and women. Under experimentally controlled alcohol intake, aggressively predisposed students were more dominant in a discussion and had higher free testosterone levels than nonag-gressively predisposed students (Lindman et al. 1987). In male hockey players the pre-play testosterone levels correlated positively with reactive aggression during the tournament (Scaramella and Brown 1978). Male patients in a clinic for nervous
The organized sports with the highest risk for head and neck injuries are football, gymnastics, wrestling, and ice hockey. Football is the sport associated with the highest risk of such injuries. Head and neck injuries also occur in a variety of nonorganized sports activities including diving, skiing, surfing, and trampoline use.
We have taken shots at most things throughout the previous chapters in this book on the principle that if you don't shoot you'll never hit the target, but at the same time we are mindful that many of the shots will inevitably miss. The aims of this final chapter are therefore to draw together the key components of the model we have presented over the previous chapters and to present some of the therapeutic and research implications that result from this framework. One of the key tests for any model is of course its usefulness, whether it ultimately turns out to be true or false. We hope to demonstrate that the SPAARS approach has within it a number of non-trivial implications for therapeutic practice, together with a number of non-trivial research predictions that, we believe, should help to distinguish it from competitor models.
A consistent finding across these studies is that in the total population, soccer is the number one sport in terms of the absolute number of injuries (Table 3.1.1). After soccer, other team games such as European team handball, volleyball, basketball and ice hockey also cause a significant proportion of the absolute number of injuries. Note that the proportions vary considerably between countries. A good example is ice hockey and skating injuries, which are common in Sweden and Finland, but rare in Norway. It is important to note that this injury pattern is a result of not only the risk involved when playing each of these sports, but also differences in participation rate for each sport. Soccer is a very popular sport in all of the Nordic countries, and ice hockey is very popular in Sweden and Finland, but not in Norway. This is reflected in concomitant differences in the number of injuries seen between these countries (Table 3.1.1). Consequently, these studies provide information...
For persons with osteogenesis imperfecta contact sports like football (tackle), ice hockey, sledge hockey and soccer should be discouraged due to the risk of fractures. Similarly it is not recommended that individuals with hemophilia take part in football (tackle) or ice hockey 58 .
This entity is commonly seen with retrocalcaneal bursitis, and frequently there is an element of insertional tendonitis as well. A prominence of the lateral aspect of the posterosuperior cal-caneus causes irritation of the retrocalcaneal and subcutaneous bursa as a result of poorly fitting shoes. This has been called Haglund's deformity or pump bump. The bump is usually asymptomatic until irritated by an abrasive heel counter. The prominence is classically present on the lateral side of the tendon at its insertion. This bump is common in women who wear high heels, but also common in hockey players and rock climbers who wear shoes with rigid heel counters. The patient population with this entity tends to be younger than those with isolated retrocalcaneal bursitis. It is not uncommon that these patients with tendo-Achilles bursitis have other features of retrocalcaneal bursitis and insertional tendonitis. Risk factors for Haglund's deformity include cavus foot, hindfoot varus, hind-foot...
Over the past decade, rates of recurrent instability with nonoperative treatment following a traumatic anterior dislocation in several studies have been reported to be between 50 and 92 . The difference in reported recurrence rates is often correlated with the age of the patients at the time of the first dislocation. In a study of young Swedish hockey players, Cvitanic et al7 reported the recurrence rate with nonoperative treatment in players younger than the age of 20 to be greater than 90 . The level of activity a patient resumes after an initial shoulder dislocation may determine his or her risk for reinjury. Once recurrent instability fails nonoperative treatment and is symptomatic, an operative approach is recommended.
Ice hockey) all involve a high amount of acceleration-deceleration forces in the form of punches, blocks, and tackles. Rotatory energy forces cause impulsive rather than impact loading forces and these are thought to cause more shearing and tensile stresses to the cerebral tissue. Trauma to the brain initiates a pathophysiological cascade of molecular and neurometabolic events (Table 2.8). These include neurotransmitter changes, ionic alterations, metabolic dysfunction, apoptosis, and inflammatory processes. A full discussion of these events is beyond the scope of this chapter however, the reader is referred to the text of Miller and Hayes for a comprehensive review.
Co-ordination, balance, proprioception and core stability are terms frequently used in sport but rather difficult to define. They involve the ability to perform, or regain, controlled movements, in a sport-specific, safe and precise way. We cannot pin-point each and every control mechanism but there is lots of experience to apply to sport. Tai chi is an excellent example of a method that aims completely to regain full body and mind control, so essential for elite sports. Martial arts and dancing focus on this type of training, which is a key to successful performance. Unfortunately, most contact sports such as soccer, rugby and ice hockey often neglect this type of training. For years I have tried to convince physiotherapists and coaches to learn from this not only would it reduce the number of injuries and their consequences, but it would enhance performance and their players' ability to undertake effective rehabilitation when injured.
In sports, examples of athlete-related precrash measures include increasing the skill level of an alpine skier to prevent falls or improving neuromuscular control around the knee or ankle to prevent the athlete from landing without proper alignment. Examples of precrash environmental measures include modifying the friction of the playing surface (too high may lead to twisting injuries to the lower extremity, too low may lead to slipping and falling injuries) or rule changes to avoid dangerous plays (e.g. checking from behind in ice hockey to avoid injuries to the spine, or a red card for tackling from behind in soccer). Equipment-related precrash measures include modifying shoe friction or cleat length to the playing surface and weather conditions.
Dental trauma is common, with one third of all dental injuries in the United States occurring with sports activities (Honsik, 2004). Mouth guards are recommended by the American Dental Association for participation in all collision and contact sports as well as weightlifting, skydiving, skateboarding, gymnastics, racquetball, squash, and skiing. Dental injury is especially common in sports combining collision and a hard ball or puck, such as ice hockey or field hockey. A study of college basketball found a significant decrease in tooth injuries in participants using custom-fitted mouth guards however, there was no decrease in oral soft tissue injury or concussion (Labella et al., 2002). Sports physicians and dental professionals agree that although off-the-shelf molded mouthpieces are less expensive and more readily available, they do not protect teeth as effectively as a custom mouthpiece (Honsik, 2004).
The requirements for the head are resistance to abrasion and wear, to brittleness when cold, and the ability to take a high polish and a discretely textured manufacturer's logo. Those for the handle are strength, low weight, low thermal conductivity and a good grip. Here we seek ideas drawn from other products that meet similar constraints, even though the application may be quite different particularly those that are designed for use at low temperatures ice hockey skates, figure skate blades, fish hooks, crampons, hiking boots, sunglasses. The ice hockey skate has a stainless steel blade that is molded into a nylon glass fiber composite sole. The figure skate blade and the fish hooks are both made of high carbon steel that has been hardened by deformation itself (forging for the hook, or stamping for the blade) and by subsequent heat treatment. The crampon is made of low alloy steel that has been stamped and bent. The harness that holds the crampon to the hiking boot is made of a...
Hand and wrist injuries are common in all sports. They are more common in children than adults 7 . A study from the Cleveland Clinic showed that 14.8 of all athletic participants under the age of 16 years sustained upper extremity injuries. Of these 16 involved the hand and 9 involved the wrist 8 . Of 113 injuries of the hand and wrist 97 occurred in football, six in soccer, three in wrestling, three in baseball, two in basketball, one in ice hockey and one in rugby. They reported 96 fractures, 35 sprains and four dislocations. Metacarpal fractures accounted for 38 of the 96 fractures. There were 12 distal radius fractures and 11 scaphoid fractures. They reported 12 thumb injuries including 12 ulnar collateral ligament tears 8 .
Roller-skating has existed since the 1880s. Inline skates are much more recent, first commercialized in the 1980s by the Rollerblade company. The first commercially successful Rollerblade skate was an ice hockey boot fitted with polyurethane wheels, a rubber heel brake and a fiberglass runner. Since then, the skates have evolved and differentiated, some with rugged wheels for mountain skating, others with detachable boots allowing quick conversion from shoes to inline wheels and some with elements that appeal specifically to women or children. And now the challenge a request to design an inline skate boot that will be used in training for cross-country skiing. It must be stiff but flexible, lightweight and impact resistant. Stiffness is needed so that the boot can be attached to the wheel platform and provide adequate rigidity for ankle support flexibility is required because, when used for cross-country training, the heel will lift off the wheel platform and the boot will flex and...
Sports-related injuries are commonly categorized into (i) macrotrauma trauma sustained during a direct sudden event, and (ii) microtrauma trauma sustained from repetitive, often low-impact, activity. Macro-trauma often occurs in sports involving some form of impact, such as a contact sport (ice hockey or football) or a high-velocity sport (downhill skiing). Knee injuries involving anterior cruciate ligament tear, joint dislocation, rupture of muscle or soft tissue injury are common examples of macrotrauma. Microtrauma is frequently seen in athletes involved in track and field events and racket sports, and result from the inability of tissues like tendon and muscle to adapt to the imposed repetitive loading. Macrotraumas are often categorized as acute injuries, while microtraumas are chronic injuries.
As an example, we have already mentioned the high incidence of ACL injuries in female team handball, which causes concern even if the total injury incidence in the sport is thought to be moderate. Ice hockey, in turn, represents a sport where the total incidence is high, and where even a high frequency of concussions and spinal cord injuries is seen 31,32 .
Instability is usually a result of an acute injury. This type of trauma is not uncommon among e.g. skiers, cyclists, ice hockey players and wrestlers (Fig. 6.6.32). In cases with extreme hyperlaxity, AC (as well as stern-oclavicular) instability may occur without trauma.
Athlete-related crash measures mainly focus on the physical preparation of athletes to allow them to withstand the forces involved when a collision or a fall occurs. Athlete-related crash measures could involve, for example, a general strength training program or falling techniques. Environmental crash measures include safety nets to avoid falling alpine skiers from flying into the crowd or soft mats protecting gymnasts who fail a dismount or fall down from apparatus. There are many examples of equipment-related crash measures in sports, possibly because they are the most obvious to consider, or because there is a potential sales profit involved. Equipment-related measures include release bindings for alpine skiing, helmets for various sports, taping and braces for ankles and other joints, shin guards for soccer players, eye guards for squash and racquetball, and visors for ice hockey.
A 14-year-old boy with no previous history of arrhythmias or syncope suddenly loses consciousness during an ice hockey game. He is unconscious for about a minute. When he arrived in the emergency department he had a fast irregular pulse. Systolic blood pressure was 70 mmHg. ECG showed pre-excited atrial fibrillation with a ventricular rate of 220-250 beats min (Fig. 4.1.5a). ECG in sinus rhythm showed pre-excitation (Fig. 4.1.5b). He was successfully treated with radiofrequency ablation and could resume full activity with no restrictions.
Ice Hockey The Game
Professional ice hockey players do not always find themselves on their home ground. With so many different competitions it is easy for a team to become involved in a variety of international competitions throughout the world.