Ice Hockey Injuries



Ice Hockey Injuries


Peter H. Seidenberg



INTRODUCTION



  • Ice hockey is an extremely fast-paced, high-contact game that requires the mastery of many skills (22,49). Many of these skills (skating, stick handling, body checking, shooting, and goal tending) are unique to the sport (41).


  • The sport dates back to the 1850s, with formal rules first established in Canada in 1881 (48).


  • It is a National Collegiate Athletic Association (NCAA), international, and Olympic sport that made its debut in the Antwerp Olympic Games in 1920 (48).


  • It is increasing in popularity yearly in the United States. During the 2009-2010 season, there were 580,714 registered players, coaches, and officials in USA Hockey. This includes 61,612 girls’ and women’s players (48).



    • USA Hockey is the governing body for amateur hockey in the United States.


  • Women are active participants in all roles in ice hockey (22,48).



    • Females were involved in Canada as early as 1892.


    • The International Ice Hockey Federation coordinated women’s world ice hockey tournaments in 1992, 1994, and 1997, and it first appeared as a medal sport in the 1998 Olympic Games.


    • Today, the NCAA considers female ice hockey an emerging sport, and USA Hockey registrants include 42,292 female players and 1,684 exclusive women’s teams.


    • Many women are playing on men’s teams, even up to the minor league level.


  • The physician providing medical care for ice hockey athletes needs to be proficient in treating a wide variety of traumatic and atraumatic problems that range in severity from mild to life threatening.




PHYSIOLOGY OF ICE HOCKEY



  • Skating during a game involves repeated accelerations, decelerations, turning, and stopping (18,41).


  • The players skate forward, backward, and side to side, often with sudden changes in direction (18,41).


  • During competition, players will typically work at > 70% of their [V with dot above]O2max with a substantial amount of play at > 90% [V with dot above]O2max (16,18).



    • However, with the frequent stoppage of play per shift (on average 2-3) and with 3-4 minutes of rest between shifts, the resulting mean [V with dot above]O2 consumed per game is 55%-66% of maximum.


  • Players can lose 4.5-6.5 pounds via sweat per game (41).


  • If games are played in consecutive days, glycogen stores are often not replenished (41).


  • Elite ice hockey players average 10% body fat (41).


  • Physiologic differences by position (41)



    • Energy expenditure



      • □ Playing time


      • □ Goalies have the least number of substitutions and may play an entire game.


      • □ Defensemen have more playing time than forwards and typically have less rest time between shifts.


      • □ Goal tending requires quick, short explosive movements interspersed with periods of relative rest.


      • □ High reliance on adenosine triphosphate (ATP)-phosphocreatine system.


      • □ Forwards and defensemen have a high reliance on both glycolytic and aerobic metabolism.


      • □ During games, adult forwards and defensemen skate greater than 4 miles.


      • □ Energy expenditure is one-third aerobic and two-thirds anaerobic; postgame lactate increases over eight times the pregame level.


    • Forwards have greater anaerobic activity and typically skate faster than defensemen or goalies.


    • Despite the above differences by position, muscle fiber composition remains equivalent between positions.


  • Flexibility (41)



    • Goalkeepers are significantly more flexible than forwards or defensemen.


    • Forwards and defensemen have been found to have equal flexibility.


  • Shooting (4,5,41)



    • Properly coordinated acceleration and deceleration of motion of body segments produces maximal velocity.


    • Motion is concentrated in the lower arm.


    • However, maximal velocity is produced through maximal use and full rotation of the trunk.


    • Accuracy of the shot is enhanced via trunk stabilization and restricted use of body segments.


EPIDEMIOLOGY OF INJURIES



  • Ice hockey is classified as a collision sport by the American Academy of Pediatrics (39).


  • There are many opportunities for injury in this aggressive, fast-paced sport.



    • Contact/collision occurs with the hard ice surface, unpadded boards, goal posts, equipment from other players (skate blades, sticks), the puck, and the bodies and, at times, fists of opponents (41).



      • □ In elite hockey, the puck can travel at speeds up to 120 miles per hour, producing impact forces > 1,250 pounds.


      • □ Professional players can skate at speeds up to 30 miles per hour.


      • □ Sliding on the ice after a fall can occur at speeds up to 15 miles per hour.


    • Fatigue appears to be a risk factor for injury (28,31,42,43).


    • Equipment that is in poor repair also places the athlete at increased risk for injury; however, even when adequate protection is worn, injury is still possible. Studies have found that 58% of injuries occur on body parts that were covered with protective equipment (31).



  • Overall injury rates



    • Aggregation of injury data is limited by varying definitions and methods for reporting in the literature.


    • Data from injuries presenting to U.S. emergency departments demonstrate the following distribution of injury location (15,21):



      • □ Upper extremity: 36.0%-43.8%


      • □ Head: 12.3%-16.3%


      • □ Lower extremity: 16.1%-19.1%


      • □ Trunk: 9.3%-13.8%


      • □ Face: 10.0%-23.0%


      • □ The above data are limited by the fact that not all ice hockey injuries result in a visit to the local emergency department.


    • Overall injury rate is 5.6 injuries per 1,000 player-hours (1.5 per 1,000 hours in practice, 54 per 1,000 hours in games) (31). Due to difficulty quantifying player-hours, many studies will instead describe injury rates per athletic exposure.


    • Injury is more common in the game setting (76%) than in practice (23%), even though practice represents significantly more time. Injuries are thus 5-25 times more common in game settings (1,2,3,31,43).


    • Acute and traumatic injures account for 85% of injuries, whereas overuse injuries represent 15% of all injuries (47).


    • Approximately 16% of injures are related to rule infractions (31).


    • During games, Pelletier et al. (36) found that 27.1% of injuries occurred during the first period, 35.6% occurred during the second period, and 26.6% occurred during the third period. In contrast, other investigators suggest that third-period injuries are roughly equal to first- and second-period injuries combined (31) or that injures are twice as common in the third period (43).


  • Age-specific injury rates: Injuries appear to increase with increasing age, with a peak in early adulthood (Table 95.1).


  • Studies suggest that injury rates in youth hockey show a dramatic increase during the first year that body checking is permitted, regardless of the age that checking is instituted (27,51).








    Table 95.1 Injury Rates by Age of Athlete (43)




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    May 22, 2016 | Posted by in SPORT MEDICINE | Comments Off on Ice Hockey Injuries

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