Ice Hockey

Jennifer Gilmore

Steven J. Karageanes

Ice hockey is a unique sport that combines speed, physical contact, skill, and dexterity on an unstable surface to create exciting competition that rivals few others. This combination also makes for many high-risk situations for injury. The top hockey players may have a higher level of multiple skills than in any other sport.

Most historians place the roots of hockey in the colder northern European regions, specifically Great Britain and France. When winter froze the numerous lakes, many forms of the sport were played on the ice. Various historical accounts of the nineteenth century describe versions of hockey played throughout various parts of Great Britain.

Modern hockey grew primarily out of Canada, and the first organized league was said to have been launched in Kingston, Ontario, in 1885, consisting of four teams. A famous portion of modern hockey tradition started in 1892, when the English Governor General of Canada, Lord Stanley of Preston, bought a silver bowl with an interior gold finish and decreed that it be given each year to the best amateur team in Canada. Over a century later, that trophy, the Stanley Cup, is awarded today to the franchise that wins the National Hockey League playoffs.

Professional hockey in the United States started in 1904 in Michigan’s Upper Peninsula. After several leagues started and folded before and around World War I, the National Hockey League was formed in 1917 and took control of Lord Stanley’s cup. Ever since then, the sport has continued to grow in popularity at all levels. Over a half million men and boys compete in the United States and Canada yearly (1), while over 43,000 Canadian women played in the 1999-2000 season alone (2).

THE GAME

Ice hockey is played on an enclosed sheet of ice approximately 200 ft by 85 ft, although international rinks are larger. The ice sheet is enclosed by boards, which are permanent in nature. Teams are made up of 20 players. Six players are on the ice at one time. Five of these players are referred to as skaters and the sixth is a goaltender. The goaltender defends a 4-ft by 6-ft goal. The players use sticks to pass, shoot, and carry a small vulcanized rubber disk, referred to as a puck, around the ice and try to put it past the opposing team’s goaltender into the net. There is physical contact—body to body, stick to body, and puck to body. Players are usually on the ice for shifts of 40 to 60 seconds. The game is played at a very high speed and involves quick decisions by all five of the skaters. The goaltending position is unique to the game, and the goaltender relies greatly on quickness and positioning to keep the puck out of the net. An official hockey game consists of three 20-minute periods making for a 60-minute game. High school hockey runs for 15-minute periods, while youth hockey runs 12 to 15 minutes per period.

Competition Levels

Ice hockey is played internationally at the Olympic level, and professional leagues are worldwide, primarily in Canada, Europe, and the United States. The elite league in the world is the National Hockey League, perhaps the most diverse professional league with respect to the number and proportions of countries represented. The National Collegiate Athletic Association (NCAA) oversees college hockey, and USA Hockey administers the sport at the youth level.
Players begin playing as early as age 4, and there is recreational hockey up to the age of 70. Historically a men’s game, the game now has women’s collegiate and Olympic competition worldwide.

APPROACH TO THE ATHLETE

Required Skills

A hockey player must possess the ability to skate, handle the puck, shoot the puck, and pass the puck. As in any sport, ice hockey demands knowledge of the game, which requires players to make very quick read and react decisions at high speed to perform the necessary skills to be successful in the game. Players who succeed at hockey possess great speed, great mental awareness of where players on their team and the opposing team are on the ice, and the knowledge of how to maneuver themselves and the puck around the opposition to score goals.

Physically, the elite hockey player requires exceptional skating skills. Speed, power, and balance are all aspects that are crucial to everyone on the ice. A goaltender may require somewhat less power than position players, but better reflexes, flexibility, and balance. Many times the goaltender is the team’s best skater.

Stick handling is an acquired skill in which a player carries the puck on the blade of the stick, controlling its movement so as to advance it without opposing players taking it away. This skill has to be executed while watching the playing surface for teammates and opponents and while maneuvering with skates on the ice.

Another skill is checking, the act of hitting an opponent player with the body or arms to impede the motion or action of the opponent. Most checks occur against the boards that surround the rink. The speed of the game combined with the boards and ice allows for high-energy collisions that contribute to the excitement of the game; consequently, it is another high injury risk situation. However, checking is an intrinsic aspect of the sport that requires skill and stamina to execute repetitively. Women’s competition and most youth hockey do not allow checking.

Training Description

Hockey players train specifically with skating, passing, shooting, and puck handling drills on the ice. These are done at top speed and involve many people to simulate gamelike conditions. The goaltender trains specifically in stopping shots that are coming at him or her. Many of the drills simulate a shift (an individual player’s time on the ice) in hockey, and the players train to exert themselves for 40-second to 1-minute shifts. Most of the training is done at a 1:3 or 1:4 work-rest ratio. Training areas of emphasis include speed, endurance, strength, flexibility, and agility. These areas of training are done both on and off the ice.

Aerobic and anaerobic training is done during conditioning, but the majority of the sport is spent on anaerobic metabolism. The defensemen skate longer shifts and with less speed than the forwards, so the former group requires more aerobic capacity. Goaltenders require sudden bursts of energy and quick burst activity, so anaerobic metabolism is predominant (1). Conditioning should be consistent with the demands of the sport.

Preventive Examination

Ice hockey is a contact sport, so traumatic injuries comprise the majority of cases seen. However, with proper physical and mental preparedness these injuries can be minimized. Chronic overuse-type injuries are greatly reduced with programs to maintain proper function. Examination of the athlete needs to first evaluate any injuries that are not fully treated or healed. Because hockey players pride themselves in stoicism and playing through injury, the medical staff needs to be comprehensive and thorough in the history and physical, particularly with previous injuries.

Flexibility and balance in muscle groups are important, not just between agonist and antagonists, but in all muscle groups (3). The trunk needs to be stable due to the unstable nature of the playing surface and requirements for balance when skating and shooting. Stretching to maintain the proper length of particular muscle
groups is very important in the off-ice training regimen. It is of particular importance to focus on the proper length of the iliopsoas and quadriceps groups not only to improve the function of skating but also to prevent low back pain.

Scapulothoracic stabilization is also important to avoid chronic overuse problems in the upper thoracic, cervical, and shoulder region. Scapulothoracic stability helps to protect the player in the event of a traumatic event as well. Strengthening of the lower trapezius and rhomboid muscle groups along with stretching the levator scapulae, scalenes, sternocleidomastoid, and upper trapezius helps to achieve scapulothoracic stability.

Adductor strains are very common in hockey players and have increased in frequency. Most blame an imbalance in strength and flexibility between the adductors and the abdominal muscles. Core stabilization programs and plyometric training can help prevent or minimize adductor strains.

Anatomic short legs can cause associated sacral base unleveling, which underlies many chronic recurrent problems, especially adductor strains, hip flexor dysfunction, and recurring low back pain. Athletes with persistent or recurring problems should be assessed for the short leg/pelvic tilt syndrome and corrected appropriately.

INJURIES

Ice hockey injuries are of both acute (traumatic) and chronic (overuse) type. The vast majority of hockey injuries (80%) are acute. A study of Finnish hockey players’ injuries reported in 1996 showed a composite rate of 14.7 for male and female players per 1,000 athlete-exposures; 70% of the 760 injuries occurred during a game (1). In the 1998-99 season, Canadian men’s collegiate hockey players had 9.19 injuries per 1,000 athlete-exposures, while females had 7.77, which was not statistically significant (4).

In a study on Canadian female players in the 1997-98 season, risk factors significantly related to injury were (a) prior injury in the past year, (b) more than 5 years of hockey experience, and (c) high exposure level.

Acute injuries can occur almost anywhere on the body, in part due to the physical contact inherent in the game. Some of the more common acute injuries are the acromioclaviclar sprain, cervical sprain, temporomandibular sprain, sprain of the medial collateral ligament of the knee joint, and ankle sprain.

Chronic injuries include adductor strains, hip flexor strain, low back pain, cervicothoracic pain, and elbow and wrist pain.

Groin Pain

Groin pain is a very common complaint among hockey players, and the incidence of groin and abdominal strain has increased in the NHL from 1995 to 2001 (3). The differential diagnosis of groin pain can be vast, including adductor strain, hip flexor strain, inguinal hernia, athletic pubalgia, hip capsular restriction, and lumbar, sacral, innominate, and pubic dysfunctions.

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