CHAPTER 86 • ICE HOCKEY INJURIES 511
- Back:Back strain and sprain—players skate in a for-
ward flexed position. This combined with the frequent
trunk rotation that accompanies shooting and passing
can place the player at risk for these injuries.
- Spondylolysis has been reported in ice hockey ath-
letes.
- Abdomen:Because of the abrupt and sudden changes
in movement (Joyner and Snouse, 2002; Sim et al,
1988), hockey players are at risk for abdominal muscle
strain.
- Athletes can sustain traumatic abdominal injury, espe-
cially when the handle of the stick is forced into the
abdomen during a collision into the boards (which is
typically the result of illegal checking).
- Thigh, groin:Anterior thigh hematomas may occur
as a result of collision with the boards or of blocking
a shot puck. These hematomas are at risk for myositis
ossificans (Sim et al, 1988) and treatment should be
directed at preventing this complication.
a. If the hematoma is identified immediately after the
game, the athlete can be placed in fixed knee flex-
ion for 24 hours in an attempt to tamponade the
bleeding thereby decreasing the size of the
hematoma.
b.Old hematomas should not be passively stretched,
as this may increase the risk of myositis ossificans.
- Adductor strains are common enough that studies
have been performed in an attempt to determine if cer-
tain players are at increased risk for this injury and to
ascertain what prevention measures can be imple-
mented in an attempt to decrease lost playing time.
Hockey players are at risk for this injury as a result of
the explosive starts and changes in direction (Joyner
and Snouse, 2002).
- Osteitis pubis
- Knee: Most common significant lower extremity
injury.
a. Although anterior cruciate ligament(ACL) and
meniscal injury has been reported, medial collat-
eral ligament (MCL) injury is 14 times more
common (Molsa et al, 1997).
b. The ACL appears to be spared because the foot
does not lock in position on the ice.
c. The mechanisms for MCL injury are both contact
and noncontact valgus stress to the knee.
- Ankle:Ankle sprain—mechanism of injury is dorsi-
flexion, eversion, and external rotation (Thompson
and Scoles, 2000), producing deltoid ligament sprain.
a. This is in contrast to most other sports where the
typical mechanism is plantarflexion, inversion, and
internal rotation, producing lateral ligament (espe-
cially anterior talofibular ligament) injury.
b. The mechanism of injury also places the hockey
athlete at risk for syndesmotic injury and
Massoneuve fracture (due to transmittal of the
force out through the fibula).
c. Ankle sprains result in 10% of major injuries in ice
hockey (defined as absence from sport greater than
28 days) (Molsa et al, 1997).
d. In an attempt to prevent these debilitating injuries,
many hockey players prefer skates that have added
external ankle support (Green et al, 1976).
- Boot lace lacerations—the ice skate blade is essen-
tially a 10–12-in. scalpel. The anterior ankle is at risk
for laceration of tendons and neurovascular structures
because of its proximity to the skates of others. A rel-
atively small laceration can cause damage to these
underlying superficial structures (Tator, 1987).
a. However, most athletes are relatively protected
from this injury because of the thickly padded
skate tongue over the anterior ankle. Athletes who
turn their skate tongue downward (out of personal
preference) place themselves at increased risk
(Tator, 1987).
- Foot:Lace bite (Joyner and Snouse, 2002)—nagging
dorsal foot pain and/or parasthesias.
a. Players often do not wear socks and prefer tight fit-
ting skates as this is thought by athletes to improve
performance and speed on the ice. The compres-
sion of the laces in such situations can cause exten-
sor tendon and nerve injuries of the dorsum of the
foot.
b. To prevent this injury, the tongue of the boot
should remain in a neutral position (Clanton and
Wood, 2003).
MEDICAL ILLNESSES
- Indoor ice rinks have ice resurfacing machines called
Zambonis that are gas or propane powered. The emis-
sions from the machine coupled with poor ventilation
can create increased carbon monoxide levels on the
ice.
- Nitrogen dioxide induced lung injury and other indoor
air quality syndromes
- Cold induced vasomotor rhinitis
a. Profuse watery rhinorrhea that typically begins
within minutes of skating on the ice. It is thought to
be the result of an overly sensitive cholinergic reflex
in response to exposure to cold air and changes in
humidity (Ayars, 2000; Bousquet et al, 2003).
b. The athlete has little nasal itching, ocular pruritis,
or sneezing, but increased nasal secretions, post-
nasal drip, sinus headaches, anosmia, and sinusitis
are common (Ayars, 2000; Bousquet et al, 2003).
c. It is a diagnosis of exclusion. Rhinitis caused by
infection, allergy, anatomic abnormalities and
