Introduction
- Timothy F. Tyler, MS, PT, ATC
- Stephen J. Nicholas, MD
Epidemiology
- •
Ice hockey and soccer players are particularly susceptible to adductor muscle strains.
- •
In professional ice hockey and soccer players throughout the world, approximately 10% to 11% of all injuries are groin strains.
- •
The level of experience is related to the incidence of groin strains.
- •
Athletes of all ages sustain groin strains.
- •
Older players have a higher incidence than younger ones.
- •
Goalkeepers have a higher incidence than position players.
Pathophysiology
- •
The adductor longus is the most commonly injured adductor during sporting activity ( Figure 24-1 ).
FIGURE 24-1
A, The location of the most frequently injured muscle in a groin strain, the adductor longus. B, An Adductor longus strain occurrence in sport.
- •
Groin strain injury is defined as any injury to the adductor muscle group that keeps a player out of a practice or a game, or requires the attention of the team physician.
- •
A groin strain is characterized by pain on palpation of the adductor tendons or the insertion on the pubic bone, or both, and groin pain during adduction against resistance.
- •
Groin strains are graded as a first degree strain if there is pain but minimal loss of strength and minimal restriction of motion. A second-degree strain is defined as tissue damage that compromises the strength of the muscle, but not including complete loss of strength and function. A third degree strain denotes complete disruption of the muscle tendon unit. It includes complete loss of function of the muscle.
Clinical Presentation
History
- •
Patient reports a feeling of a tearing in the groin region.
- •
Pain on push off injured lower extremity or change in direction.
- •
Decreased stability of the involved lower extremity on single leg stance.
- •
Inability to kick a ball.
- •
Inability to take slap shot/load body weight quickly on injured lower extremity.
Physical Examination
Abnormal Findings
- •
Decreased muscle force of the adductors.
- •
Pain on contraction of the adductor muscle group.
- •
Pain to passive abduction motion beyond normal range.
- •
Pain on palpation of the origin of the adductor longus.
- •
Inability to single limb stand against perturbation.
- •
A palpable defect of the muscle belly of the adductor longus.
- •
Ecchymosis in groin region.
- •
Swelling in groin region.
- •
Decreased step length.
Pertinent Normal Findings
- •
Symmetrical adductor force production of both lower extremities.
- •
Adductor strength greater than 80% abductor strength within each leg.
Imaging
- •
X-rays
- •
CT scan
- •
MRI ( Figure 24-2 )
FIGURE 24-2
An MRI of a grade 3 adductor strain.
Differential Diagnosis
- •
Athletic pubalgia: injury to the transversalis fascia leading eventually to incompetency of the posterior inguinal wall. A diagnosis of exclusion
- •
Osteitis pubis: increased uptake on bone scan or CT scan at the pubic symphysis.
- •
Hernia: positive inguinal hernia exam.
- •
Hip-joint osteoarthrosis: hip X-ray revealing avascular necrosis or osteoarthritis of hip.
- •
Rectal or testicular referred pain: MRI of suspected region.
- •
A coexisting fracture of the pelvis or the hip: seen on X-ray.
- •
Hip flexor strain.
Treatment
Nonoperative Management
- •
Bracing/spica ( Figure 24-3 )
FIGURE 24-3
Example of a hip spica to provide support and protection to the adductors.
- •
Rehabilitation
- •
Correction of faulty biomechanics
- •
PRP
Guidelines for Choosing Among Nonoperative Treatments
- •
No bony avulsion
- •
No sports hernia
Surgical Indications
- •
Avulsion of the adductor longus
- •
Sports hernia
Aspects of History, Demographics, or Exam Findings that Affect Choice of Treatment
- •
The degree of the groin strain.
- •
Whether a palpable defect is present.
Aspects of Clinical Decision Making When Surgery Is Indicated
- •
MRI revealing bony involvement.
- •
Failed greater than 6 months of nonoperative treatment.
Evidence
Multiple Choice Questions
- QUESTION 1.
When building an injury prevention program for groin strain, which muscle group should be strengthened?
- A.
Abductors
- B.
Adductors
- C.
Hip flexors
- D.
Hamstrings
- A.
- QUESTION 2.
What is one of the strongest intrinsic factors that predisposes an athlete to a groin injury/strain?
- A.
Strength ratio of the adduction to abduction muscle groups
- B.
Increased preseason practice sessions
- C.
Previous groin strain
- D.
A lack of mechanical advantage for the adductor longus
- A.
- QUESTION 3.
In a clinical examination, pertinent normal findings to look for may include:
- A.
Swelling in the groin region
- B.
Decreased muscle force of the adductors
- C.
Pain on contraction of the adductor muscle group
- D.
Symmetrical adductor force production of both lower extremities
- A.
- QUESTION 4.
A general guideline for choosing a nonsurgical treatment option consist of:
- A.
Avulsion of the adductor longus
- B.
Sports hernia
- C.
No bony avulsion
- D.
Hip fracture
- A.
- QUESTION 5.
An increased uptake on a bone scan or CT scan may differentiate which of the following from a diagnosis of groin strain?
- A.
Osteitis pubis
- B.
Athletic pubalgia
- C.
Hernia
- D.
Hip-joint osteoarthrosis
- A.
Answer Key
- QUESTION 1.
Correct answer: B (see Pathophysiology )
- QUESTION 2.
Correct answer: C (see Pathophysiology )
- QUESTION 3.
Correct answer: D (see Clinical Presentation )
- QUESTION 4.
Correct answer: C (see Treatment )
- QUESTION 5.
Correct answer: A (see Differential Diagnosis )
Nonoperative Rehabilitation of Adductor and Hip Joint Strains
- Timothy F. Tyler, MS, PT, ATC
- Stephen J. Nicholas, MD
- •
Pain
- •
Range of motion
- •
Restore the adduction-to-abduction strength ratio of the injured leg
- •
Function
Phase I (weeks 0 to 3 to 6)
Protection
- •
Compression shorts or a wrap bandage may be helpful in decreasing swelling and provide support.
- •
If walking causes pain, limit weight bearing; crutches are considered for the first day or two after the injury.
| PHASE I (weeks 0 to 4) | PHASE II (weeks 4 to 8) | PHASE III (weeks 8 to 12) | PHASE IV (weeks 12+) |
|---|---|---|---|
|
|
|
|
Management of Pain and Swelling
- •
RICE (rest, ice, compression, elevation) is the standard protocol for mild to moderate muscle strains for the first 24 to 48 hours.
- •
Electrical stimulation, cold laser, or ultrasound can be useful in healing.
Techniques for Progressive Increase in Range of Motion
Therapy Techniques
- •
Gentle pain-free sub maximal contractions within 48 hours. Maintain pain-free available passive range of motion.
Soft Tissue Techniques
- •
Gentle massage to the area with ice to help decrease swelling.
Other Therapeutic Exercises
- •
Biking for maintaining fitness
- •
Upper body and trunk strengthening
- •
Core stability
Activation of Primary Muscles Involved
- •
Submaximal isometric adduction with knees bent ( Figure 24-4 ), with knees straight progressing ( Figure 24-5 ) to maximal isometric adduction.
FIGURE 24-4
Submaximal adductor strengthening with short lever arm.
FIGURE 24-5
Submaximal adductor strengthening with long lever arm.
- •
If pain free, progress to side-lying hip adduction against gravity ( Figure 24-6 ).
FIGURE 24-6
Side-lying hip adduction against gravity.
- •
Hip passive range of motion (PROM) in pain-free range.
Sensorimotor Exercises
- •
Bilateral balance board
- •
Single leg stance on stable surface
Open and Closed Kinetic Chain Exercises
Nonweight-bearing hip progressive resistive exercises (PREs) without weight in antigravity position (all except abduction), pain-free, low load, high repetition exercises.
- •
Mini squats to full squats
Techniques to Increase Muscle Strength, Power, and Endurance
- •
Contralateral LE strengthening
Neuromuscular Dynamic Stability Exercises
- •
Flexibility program for noninvolved muscles
Sport-Specific Exercises
- •
Hockey: stick-handling while standing with the ball
Milestones for Progression to the Next Phase
- •
Pain-free passive range of motion
- •
Minimal swelling as measured by clinical palpation and observation.
- •
Concentric adduction against gravity without pain.
- •
Normal gait with full weightbearing
Phase II (weeks 3 to 6 and weeks 6 to 8)
Protection
- •
Compression shorts
- •
Hip spica
Management of Pain and Swelling
- •
Electrical stimulation
- •
Cold laser
- •
Ultrasound
- •
Ice
Techniques for Progressive Increase in Range of Motion
Manual Therapy Techniques
- •
Manual resistance to adductors. Providing minimal resistance to the leg proximal then moving more distally towards the ankle. Resistance should always be pain free.
Soft Tissue Techniques
- •
Graston technique and/or deep tissue massage. Gentle massage to the knee to milk the fluid away from the groin
Stretching and Flexibility Techniques for the Musculotendinous Unit
- •
Initiate gentle PROM of adductor and hip flexors. Gentle stretching so as not to cause plastic deformation of the muscle.
Other Therapeutic Exercises
- •
Elliptical
- •
StairMaster
- •
Treadmill long stride walking
- •
Bicycling
- •
Swimming
Activation of Primary Muscles Involved
- •
Concentric adduction with weight against gravity. Start with 2 lbs and try to achieve 3 sets of 10, then move to 3 sets of 15 followed by 1 set of 30 at the same weight. If the patient can perform 1 set of 30 with that weight, add 2 lbs and go back to doing 3 sets of 10 repetitions.
- •
Adduction in standing on cable column or Thera-Band. Start the athlete with yellow Thera-Band and then move to red once they achieve 30 repetitions with perfect form.
- •
Seated adduction machine. Use a pain free resistance level so the patient can achieve 3 sets of 10.
- •
General flexibility program. Perform a general flexibility assessment looking for asymmetrical tightness from anterior to posterior or restrictions from involved noninvolved sides.
Sensorimotor Exercises
- •
Single-leg stance standing on the floor, the patient is bare foot, knee slightly bent and eyes open. Perform SLS for 30 seconds. Try and achieve this 3 times. If the patient can perform easily without pain or loss of balance, progress to 1 minute for 3 sets. If patient cannot perform for 30 seconds or 1 minute, decrease time and/or add UE support. This exercise can be progressed by adding an unstable surface (BAPS, Thera-Band, stability pad etc.)
- •
Quick steps: Quick alternating steps over a line on the floor. Count the number of repetitions.
- •
Tic tock: Feet shoulder width apart and pass the ball back and forth quickly between feet.
- •
Lateral band walks ( Figure 24-7 )
FIGURE 24-7
Lateral band walks.
- •
Balance board tosses: Patient in mini squat position, perform 30 tosses in a row without touching either side of board to the floor. Perform this 3 times. Progress to overhead throw and side chops while maintaining balance.
Open and Closed Kinetic Chain Exercises
- •
Sumo squats ( Figure 24-8 ): Begin with 3 sets of 10, stand on the floor with pain-free and proper form, add a kettle bell for resistance.
FIGURE 24-8
Sumo squats.
- •
Contralateral Thera-Band: Stand on the involved leg and move the noninvolved leg into different planes of motion, for example hip abduction/extension.
- •
Leg Press: Perform 3 sets of 10 progressing to 3 sets of 12 and 3 sets of 15 with two legs in pain-free resistance. Progress to single leg.
Neuromuscular Dynamic Stability Exercises
- •
Standing with involved foot on sliding board moving in frontal plane ( Figure 24-9 )
FIGURE 24-9
Standing with involved foot on sliding board moving in frontal plane.
- •
Balance board squats with throwbacks: With patient in mini squat position, perform 30 tosses in a row without touching either side of the board to the floor. Perform this 3 times. Progress to overhead throw and side chops while maintaining balance.
Plyometrics
- •
Lateral shuffles: Maintain proper alignment in mini squat position (watch for knees diving in) shuffle side to side across the room. Begin at 50% speed pain-free and progress to 75% and then full speed.
Functional Exercises
- •
Lunges (forward and lateral) with reciprocal arm movements.
- •
Unweighted spilt jumps: Explosively jump while using the arms to assist as needed. While in mid-air switch the leg position landing softly in lunge position. Progress for maximum height and power.
- •
Forward/backward running drills: Begin at 50% and progress to 75% to then full speed. Therapist can add in directional changes.
Sport-Specific Exercises
- •
Bilateral adduction on sliding board moving in frontal plane (i.e., bilateral adduction simultaneously). Standing on sliding board slide both legs together. Perform as many as patient can pain-free.
- •
Skater strides ( Figure 24-10 ): In skating position, see how many times the patient can go back and forth along the slide board. Increasing the number of reps and speed as they progress within the same timeframe.
FIGURE 24-10
Skater strides.
Milestones for Progression to the Next Phase
- •
Involved lower extremity PROM equal to that of the uninvolved side
- •
Involved adductor strength at least 75% that of the ipsilateral abductors. This is determined by performing a break test using a hand held dynamometer.
Phase III (weeks 6 to 8 and weeks 9 to 12)
Protection
- •
Hip spica
Management of Pain and Swelling
- •
Biofreeze
- •
Ice
- •
Compression wrap
Techniques for Progressive Increase in Range of Motion
Manual Therapy Techniques
- •
Manual resistance to adductors
Soft Tissue Techniques
- •
Graston technique and/or deep tissue massage
Stretching and Flexibility Techniques for the Musculotendinous Unit
- •
Progressive stretching of the adductors
Other Therapeutic Exercises
- •
Phase II exercises with increase in load, intensity, speed, and volume
- •
Core stability with/without stability ball: planks, side planks, double-leg/single-leg bridges. Use a time based approach starting at 30 seconds progressing to one minute.
Activation of Primary Muscles Involved
- •
Eccentric lengthened state strengthening of the adductors
- •
Ring squeezes ( Figure 24-11 )
FIGURE 24-11
Ring squeezes.
- •
Ring squeezes in table top position ( Figure 24-12 )
FIGURE 24-12
Ring squeezes in table top.
- •
Hip adductor machine
Sensorimotor Exercises
- •
Slide board side to side
Open and Closed Kinetic Chain Exercises
Standing resisted stride lengths on cable column to simulate skating
Techniques to Increase Muscle Strength, Power, and Endurance
- •
Lunges (in all planes)
Neuromuscular Dynamic Stability Exercises
- •
Single-leg cable column ice skating stride
- •
Quick kick with Thera-Band
- •
Perturbation training
Plyometrics
- •
Bounding side to side
Functional Exercises
- •
Correct or modify ice skating technique
Sport-Specific Exercises
- •
On ice kneeling adductor pull togethers
Milestones for Progression to Advanced Sport-Specific Training and Conditioning
- •
Adduction strength, at least 90% to 100% of the abduction strength. This is determined by performing a break test using a hand held dynamometer.
- •
Involved adductor muscle strength equal to that of the contralateral side. This is determined by performing a break test using a hand held dynamometer.
Phase IV (weeks 12+)
Protection
- •
Hip spica
- •
Compression shorts
Management of Pain and Swelling
- •
Ice
Techniques for Progressive Increase in Range of Motion
Manual Therapy Techniques
- •
Contract-relax
Soft Tissue Techniques
- •
Massage
Stretching and Flexibility Techniques for the Musculotendinous Unit
- •
Stretching of the adductors
Other Therapeutic Exercises
- •
Running
- •
Squats
- •
Dead lifts
- •
Cleans
- •
Snatches
Activation of Primary Muscles Involved
- •
Heavy load eccentrics of adductors and hip flexors
Sensorimotor Exercises
- •
Ice skating with drill
Open and Closed Kinetic Chain Exercises
- •
Split squats ( Figure 24-13 )
FIGURE 24-13
Split squats.
Techniques to Increase Muscle Strength, Power, and Endurance
- •
Timed slide board slides
Neuromuscular Dynamic Stability Exercises
- •
Ice single-limb stance
Plyometrics
- •
Box jumps
Milestones to Progress to Sport-Specific Training and Conditioning
- •
Pain-free range of motion
- •
Pain-free ice skating
- •
Symmetrical strength of adductors in shortened, mid range and lengthened state of the muscle. We determine this by performing a break test using a hand held dynamometer. Approximately 10° from the most shortened muscle length and 10° from the longest muscle length.
- •
No limiting symptoms with full speed functional drills
Criteria for Abandoning Nonoperative Treatment and Proceeding to Surgery or More Intensive Intervention
- •
No response in returning strength
- •
Grade 3 tear
Tips and Guidelines for Transitioning to Performance Enhancement
- •
All motion loaded and unloaded in the frontal sagittal and transverse plane should be pain free.
- •
During this period there should be no movement deviations or compensations.
Performance Enhancement and Beyond Rehabilitation: Training/Trainer and Optimization of Athletic Performance
- •
Perturbation training on and off the ice
Specific Criteria for Return to Sports Participation: Tests and Measurements
- •
Confidence in the lower extremity.
- •
100 % recovery. Ask the patient what percent of 100% are they today, and then compare this to the uninjured side.
Evidence
Multiple-Choice Questions
- QUESTION 1.
Which is not an appropriate clinical guideline for progressing from Phase I to Phase II?
- A.
Pain-free PROM
- B.
Minimal swelling
- C.
Abduction strength
- D.
Pain-free concentric adduction against gravity
- A.
- QUESTION 2.
Which of the following should be avoided in Phase I?
- A.
Adductor strengthening
- B.
Submax isometrics
- C.
Ultrasound
- D.
Ice
- A.
- QUESTION 3.
What factors have been proven to put athletes at risk for adductor strains?
- A.
Gender
- B.
History of ITB friction syndrome
- C.
Ambient temperature
- D.
Poor hip adductor to abductor ratio
- A.
- QUESTION 4.
Which of the following is NOT a guiding principle of rehab for an adductor strain?
- A.
Thigh girth
- B.
ROM
- C.
Function
- D.
Restoring abduction to adduction strength ratio
- A.
- QUESTION 5.
What added protection may a sports clinician give to a player to return to play?
- A.
Tape
- B.
Thera-Band
- C.
Hip spica
- D.
Underwear
- A.
Answer Key
- QUESTION 1.
Correct answer: B (see Phase I )
- QUESTION 2.
Correct answer: A (see Phase I )
- QUESTION 3.
Correct answer: D (see Introduction , Evidence )
- QUESTION 4.
Correct answer: A (see Guiding Principles )
- QUESTION 5.
Correct answer: C (see Phase IV )
Beyond Basic Rehabilitation: Return to Hockey after Adductor Strain
- Timothy F. Tyler, MS, PT, ATC
- Stephen J. Nicholas, MD
Introduction
- •
Balance
- •
Agility
- •
Strength
- •
Power
- •
Kinetics
- •
Anaerobic power
- •
Speed endurance and training
- •
Groin strains are a prevalent pathology associated with ice hockey and have a high recurrence rate.
- •
It is particularly challenging to return to the sport because the player needs stability on a single leg on a skate blade, which requires adductor strength.
- •
The three mechanisms of ice hockey hip and adductor strains are ( Figure 24-14 A, B, and C ):
- •
Excessive ROM
- •
Contact with an opposing player
- •
Contact with ice
FIGURE 24-14
The three mechanisms of ice hockey hip and adductor strains. A , Excessive ROM. B , Contact with an opposing player. C , Contact with ice.
- •
Phase I : Advanced Strength and Conditioning Programs
Periodization
- •
Linear
- •
Microcycles
| PHASE I | PHASE II | PHASE III |
|---|---|---|
|
|
|
Program Design/Performance Training Program
Sport-Specific Concepts of Integrated Training
- •
Training continuum
- •
Flexibility/joint mobility for joint stability
- •
Training with hockey posture
- •
Sensorimotor and balance training
- •
Core training
- •
Cardiorespiratory training
- •
Multiplanar training activities
- •
Training for optimum muscle balance
- •
Training for optimum muscle functional strength
- •
Training for optimum muscle functional power
- •
Neuromuscular dynamic stability exercises
- •
Training for speed, agility, quickness (SAQ)
- •
Plyometric training
- •
Functional training
- •
Sport-specific training
Olympic Lifts Used in the Training Program
- •
Snatch
- •
Clean and jerk
- •
Power clean
Training Principles Used in the Design of the Program
- •
Principle of progression
- •
Principle of overload
- •
Principle of variation
- •
Principle of individualization
- •
Principles of specificity–specific adaptation to imposed demands (SAID)
Application of Acute Training Variables
- •
High repetitions
- •
5 to 14 sets
- •
30 to 60 second rest interval
- •
Moderate intensity
- •
Training frequency of TIW
- •
Training duration of 10 to 20 minutes
- •
Training volume of 8 to 14 sets
- •
Specific exercises used in the training are sumo squats, on-ice squeezes, isometric ball squeezes.
Phase II: Performance Enhancement Training Techniques
Periodization
- •
Linear
- •
Undulating
- •
Macrocycles
- •
Mesocycles
- •
Microcycles
Program Design/Performance Training Program
Sport-Specific Concepts of Integrated Training
- •
Core training
- •
Cardiorespiratory training
- •
Multiplanar training activities
- •
Training for optimum muscle balance
- •
Training for optimum muscle functional strength
- •
Training for optimum muscle functional power
- •
Neuromuscular dynamic stability exercises
- •
Training for speed, agility, quickness (SAQ)
- •
Plyometric training
- •
Functional training on the ice
- •
Sport-specific training on the slide board
Olympic Lifts used in the Training Program
- •
Snatch
- •
Clean and jerk
- •
Power clean
Training Principles Used in the Design of the Program
- •
Principle of progression
- •
Principle of overload
- •
Principle of variation
- •
Principle of individualization
- •
Principles of specificity–specific adaptation to imposed demands (SAID)
Application of Acute Training Variables
- •
6 to 12 repetitions
- •
8 to 10 sets per body part
- •
Rest interval of 60 seconds
- •
High intensity
- •
Slow repetition tempo
- •
Training frequency of 48 hours rest for each body part
- •
Training duration of 6 to 10 weeks
- •
Training volume of no more than 30 repetitions
- •
Specific exercises used in the training
- •
Split squats (See above: gives some guidelines to the readers regarding volume of training for the different exercises)
- •
Squats
- •
Lunges
- •
Slide board
- •
Diagonal PNF
- •
Light agility program with on-ice directional changes
- •
Application of Chronic Training Variables
- •
Repetition to create muscle memory.
Phase III: Sport-Specific Training
Periodization
- •
Linear
- •
Macrocycles: full year and will rest after the season is over
- •
Mesocycles: resistance training to balance adductor to abductor strength ratio.
- •
Microcycles: individual sport specific eccentric training
Program Design/Performance Training Program
Sport-Specific Concepts of Integrated Training
- •
Training continuum
- •
Flexibility/joint mobility for joint stability
- •
Sport-specific on-ice training
Training Principles Used in the Design of the Program
- •
Principle of progression: The Delorme principle is recommended to progress resistance training.
- •
Principle of overload: The Oxford training principles are recommended.
- •
Principle of variation: Perform dry land training 2 times per week during the hockey season.
- •
Principle of individualization: An example of this is to emphasize the end range strength in goaltenders who are functioning often in their end ROM.
Application of Acute Training Variables
- •
2 to 5 repetitions on-ice
- •
2 minute rest interval
- •
Maximum intensity
- •
Repetition tempo as fast as the athlete can
- •
Daily training frequency
- •
10 to 20 minute training duration
- •
High training volume
- •
Specific exercises used in the training
- •
Forward skating
- •
Backwards skating
- •
Clockwise cross overs
- •
Counter clockwise cross overs
- •
One on ones
- •
Two on ones
- •
Three on twos
- •
Scrimmage no contact
- •
Scrimmage with checking
- •
Game
- •
Application of Chronic Training Variables
- •
Applied to the athlete’s tolerance.
Sports Performance Testing
General Information
- •
General history
- •
Subjective questionnaires
- •
Medical history
- •
Sports injury history
- •
Surgical history
- •
Chronic conditions/medication
- •
Impact testing
- •
Eye exam
Specific Criteria for Progression to the Next Stage to Determine their Readiness for Hockey
Objective Tests
- •
Physiological assessments. Girth measurements to asses for atrophy.
- •
Body composition tests BMI, skin-fold testing.
- •
Movement performance testing to look for ROM and strength deficits forward and backward shuttle runs looking for asymmetrical body movement.
- •
Sport-specific testing: Timed slide board slides.
- •
Impact testing for concussion management.
- •
On-ice testing: Timed circles in both directions to assess single limb stance ability on skates.
Criteria for Determining Readiness for Sport
- •
Rate of perceived exertion
Specific Criteria for Releasing an Athlete to Unsupervised Complete Participation in Hockey
- •
Pain-free full ROM and strength throughout the range.
- •
Symmetrical adduction strength, symmetrical single-leg hop for distance. Hand held dynamometer testing in which the involved hip adductors are 80% of the hip abductors of the involved leg.
- •
Subjective 100% confidence of patient that they are ready to return.
Recommended Ongoing Exercises
- •
Standing unilateral elastic resistance, slide board, balance board.
Evidence
Multiple-Choice Questions
- QUESTION 1.
Where should most sport specific training be done?
- A.
On ice
- B.
Gym
- C.
Training room
- D.
At night at home
- A.
- QUESTION 2.
What is a good acute training exercise for warming up?
- A.
Box jumps
- B.
Isokinetics
- C.
Sumo squats
- D.
Ultrasound
- A.
- QUESTION 3.
Repeated sprints should take how long to complete?
- A.
Each 5 to 6 minutes to complete
- B.
All day
- C.
Each takes 4 to 6 seconds
- D.
Each takes 45 to 60 seconds
- A.
- QUESTION 4.
Why is it particularly challenging to return to hockey after a groin strain?
- A.
Hockey players have less stability than other athletes
- B.
Younger people play hockey
- C.
Most are multisport athletes
- D.
The player needs stability on a single leg on a skate blade, which requires adductor strength
- A.
- QUESTION 5.
During speed training the training should include how many turns?
- A.
4
- B.
3
- C.
9
- D.
1
- A.
Answer Key
- QUESTION 1.
Correct answer: A (see Box 24-1 )
Box 24-1
Advanced Rehabilitation Program
On- and Off-Ice Workouts
On-Ice Workouts
Anaerobic Power Training
- •
Repeated sprints that each take 45 to 60 seconds to complete. Move goals forward to approximately in line with the end zone face-off spots and have athletes skate 3 laps as fast as they can. Rest period should be 4 to 6 times the sprint time. Players should complete 6 to 8 sets. The rest time can be dictated by how many players are in a group.
- •
For example, if you want a 5 : 1 recovery to sprint ratio and you have 18 players, divide the players into 3 groups of 6 with each group stationed at different points around the ice. The first players in each group complete their first set, then the 2 nd players go and so on until all 6 players have completed their first set of 3 laps. Then the first 3 players start their 2 nd set.
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Direction should be reversed between each set and the goals should be moved to spread the wear on the ice.
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The distance can be fixed by tying a rope between both goals. When the goals are moved, to spread the wear on the ice, make sure the rope remains taught.
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Regardless of how the workout is executed the goal is to have players go all out for 45 to 60 seconds and give them 4 to 6 minutes recovery and repeat 6 to 8 times.
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The distance will depend on the time after injury of the athlete. The shorter the recovery time the slower the subsequent sets.
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The traditional mentality is to have short recovery times so everyone is exhausted for the last couple of sets and crawl over the finish line (no pain no gain mentality). Training adaptations will be better if there is only a small decline in speed from first to last sets.
Speed Endurance Training
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Repeated sprints that each take 20 to 30 seconds to complete. Figure of 8 sprints performed across the width of the ice, where players start in the middle and have to complete 3 laps (i.e. cross their starting point 6 times).
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The recovery to sprint ratio should be the same or similar to the anaerobic power training i.e. 4 : 1, 5 : 1, or 6 : 1.
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This test is more technically demanding than anaerobic power training because skating ability during turns is critical. Thus this tests a combination of skating ability and fitness.
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The practical issue in doing this test is wear on the ice. Actual distance can be manipulated to match the fitness of the players to stay within the 20 to 30 second time requirements.
Speed Training
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All out sprint with only 1 turn. The goal is to test instantaneous power.
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For example, start on goal line, sprint to opposite goal line and back to blue line at end where you started (292 foot sprint).
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This should take approximately the same time as the figure of 8 test, but should only be repeated a max of 6 times, with the same 4 to 6 : 1 recovery : sprint ratio.
Off-Ice Workouts
Aerobic Power
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On track 200 meters in 45 second, 200 meters in 90 seconds, repeat 10 to 12 times. This workout is designed for athletes with a VO 2 max of 50 ml/kg/min.
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If you want an accurate measure of their VO 2 max have them run 8 laps (2 miles) and get an accurate time for their max effort. A VO 2 max of 50 ml/kg/min equates to 2 miles in 14 min.
Anaerobic Power
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30 meter sprint every 30 seconds repeated 6 times, 2 minute recovery, repeat 6 times.
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Players can do alternating 20 sit-ups or pushups during 2 minute recovery.
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In any of these sprint workouts (on-ice or off-ice) it is essential to provide sufficient recovery so that the later sprints are not performed at walking speed.
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Some decrement is expected, but if it is no longer a sprint, that is, they are too fatigued to go fast, then the exercise is not going to be beneficial.
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The key to training the targeted energy systems is quality of the sprint.
Strength workouts
Squats *
* Do numbers 1 and 2 on one day and numbers 3 and 4 on another day
- 1.
Single-leg split squats with rear leg held back and parallel to ground (2 × 15 or 20)
- 2.
Single-leg split squats with rear leg back and up on bench (approx. 3 feet high) (2 × 15 or 20)
- 3.
Walking split squats; also called lunge walking (20 repetitions)
- 4.
Split squat plyometric jumps; also called lunge jumping (2 × 15 or 20)
Jumps
- 1.
Lateral jumps: single leg lateral jumps across markings 2 feet apart. Jump for 10 seconds (count repetitions). Do 4 sets each leg, alternating between legs.
- 2.
Skater jumps: lateral jumps across a 5 foot distance (6 feet for adults). Take off on 1 leg and land on the other leg. Do 10 repetitions, rest 1 minute, do 3 sets.
Other
Sit-ups and pushups as needed.
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- QUESTION 2.
Correct answer: C (see Warm-up phase of guidelines)
- QUESTION 3.
Correct answer: D (see Box 24-1 )
- QUESTION 4.
Correct answer: D (see Introduction )
- QUESTION 5.
Correct answer: D (see Box 24-1 )
Nonoperative Rehabilitation of Hamstring Strains and Contusions
- Marc Sherry, PT, DPT, LAT, CSCS, PES
- Bryan C. Heiderscheit, PT, PhD
- William Clancy, MD, PhD
- Bryan C. Heiderscheit, PT, PhD
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Excessive or aggressive stretching of the injured hamstrings should be avoided, as this can result in a dense scar formation in the area of injury prohibiting muscle regeneration. However, early mobilization and movement, with pain defining the range of motion limit, is safe and effective for return to sport with minimal chance for injury recurrence.
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Rehabilitation interventions should focus on progressive agility, trunk stabilization, eccentric strengthening and eliminating muscle imbalances.
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Specific evaluation of strength, mobility and apprehension are key indicators for return to sport readiness.
Related posts:
Epiphyseolysis and Osteochondritis
Cervical Spine Disc Injuries
Lateral Collateral Ligament and Posterolateral Ligament Injuries
Triangular Fibrocartilage Complex Injuries
Leg Pain in the Athlete: Stress Fractures, Medial Tibial Stress Syndrome, and External Compartment Syndromes
Ulnar Collateral Ligament Injuries
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