Injuries in Ice Hockey

Injuries in Ice HockeyInjuries in Ice Hockey
Adriano VretarosAdriano Vretaros
Strength and Conditioning CoachStrength and Conditioning Coach
São Paulo – BRAZILSão Paulo – BRAZIL
avretaros@gmail.comavretaros@gmail.com

Types
●
AccidentsAccidents
●
Musculoskeletal InjuriesMusculoskeletal Injuries
●
Pathologies of the AirwaysPathologies of the Airways

Researches
●
Definition of InjuryDefinition of Injury
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EpidemiologyEpidemiology
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Investigated PeriodInvestigated Period
●
General Injuries and or Specific InjuryGeneral Injuries and or Specific Injury
●
In the Game, Practice and or TrainingIn the Game, Practice and or Training
●
Tactical RoleTactical Role

Definition of Injury - IDefinition of Injury - I
●
Harmony betweenHarmony between DIFFERENT DEFINITIONSDIFFERENT DEFINITIONS
●
Sport FormationSport Formation vs.vs. Competitive SportCompetitive Sport
a)a) Ability Body Tolerate LoadsAbility Body Tolerate Loads
b)b) Behavioral Factors, Physiological and BiomechanicalBehavioral Factors, Physiological and Biomechanical
AdaptationsAdaptations
c)c) Uniformity PlansUniformity Plans (Prevention, Treatment and(Prevention, Treatment and
Rehabilitation)Rehabilitation)
d)d) Structural and Functional IntegrityStructural and Functional Integrity
(Atalaia, Pedro & Santos, 2009)(Atalaia, Pedro & Santos, 2009)

Definition of Injury - IIDefinition of Injury - II
●
AcuteAcute oror ChronicChronic
●
ContactContact oror No ContactNo Contact
●
ExtrinsicExtrinsic oror Intrinsic FactorsIntrinsic Factors

EpidemiologyEpidemiology
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IncidenceIncidence
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PrevalencePrevalence

Investigated PeriodInvestigated Period
●
Day (s)Day (s)
●
Week (s)Week (s)
●
Month (s)Month (s)
●
Season (s)Season (s)
●
Pre-season (s)Pre-season (s)
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Off-season (s)Off-season (s)

General Injuries and or Specific InjuryGeneral Injuries and or Specific Injury
●
GeneralGeneral oror LocalLocal
●
If Location:If Location:
a)a) HeadHead
b)b) TrunkTrunk
c)c) Upper LimbUpper Limb
d)d) Lower LimbLower Limb

Tactical RoleTactical Role
● Case Study
● Function (s):
Forwards
Defensemen
Goaltender

Motor Actions in Ice Hockey - I
●
CHARACTERISTICS:CHARACTERISTICS:
a)a) Start and StopStart and Stop
b)b) One-on-oneOne-on-one
c)c) Intermittent Collision Sport (Intermittent Collision Sport (naturenature))
d)d) Explosive Dynamic Movements PatternsExplosive Dynamic Movements Patterns
●
GAME TASKS:GAME TASKS:
1)1) Closed Kinetic Chain MovementsClosed Kinetic Chain Movements
2)2) Absolute StrengthAbsolute Strength
3)3) Muscular PowerMuscular Power
4)4) Endurance (MacLean,Endurance (MacLean, no dateno date))

Motor Actions in Ice Hockey - II
●
Rotational Movements:Rotational Movements:
a)a) HipHip
b)b) TrunkTrunk
c)c) ShouldersShoulders
●
Slap ShotSlap Shot (Force Generated)(Force Generated)::
1)1) 25% Trunk25% Trunk
2)2) 40-45% Shoulders40-45% Shoulders
3)3) 30-35% Elbow and Wrist30-35% Elbow and Wrist
(Raether, 2014)(Raether, 2014)

Motor Actions in Ice Hockey - III
●
Externally and InternallyExternally and Internally Rotate the HipRotate the Hip
●
Strong Connection:Strong Connection: LPH, Trunk and ShoulderLPH, Trunk and Shoulder
●
SkatingSkating (acceleration, deceleration, checking)(acceleration, deceleration, checking)
●
Stick SkillsStick Skills (passing, shooting, checking)(passing, shooting, checking)
(Roether, 2014)(Roether, 2014)

Motor Actions in Ice Hockey - IV
●
SKATING TECHNIQUES PRINCIPLES:SKATING TECHNIQUES PRINCIPLES:
a)a) Force GenerationForce Generation
b)b) Circle PhysicsCircle Physics
c)c) Center of GravityCenter of Gravity
d)d) AccelerationAcceleration
e)e) MomentumMomentum
f)f) InertiaInertia
(Stamm, 2010)(Stamm, 2010)

Real Problems - I
●
Complex Motor Skills at aComplex Motor Skills at a High Rate of SpeedHigh Rate of Speed
●
AbsorbAbsorb Physical ContactPhysical Contact from Opposing Playersfrom Opposing Players
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React to aReact to a Constantly Changing EnviromentConstantly Changing Enviroment
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To BalanceTo Balance on One-eighth Inch Wide Blades of Steelon One-eighth Inch Wide Blades of Steel
●
StrengthStrength to Maintain Balanceto Maintain Balance
●
Violent GameViolent Game Played atPlayed at High VelocitiesHigh Velocities
●
Very UnforgivingVery Unforgiving SurfaceSurface
(Rolinski, 2013)(Rolinski, 2013)

Real Problems - II
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Ice Skating:Ice Skating: Trunk Flexion ForwardTrunk Flexion Forward
●
Isometric Contraction of theIsometric Contraction of the Extensors BackExtensors Back
●
ActionsActions Stressful TorsionsStressful Torsions
●
Unequal Distribution: Absorb Forces ofUnequal Distribution: Absorb Forces of CompressionCompression
andand Shear StrengthShear Strength
●
Forces ImpactsForces Impacts (contacts)(contacts)
(MacLean,(MacLean, no dateno date))

Real Problems - III
●
Game EquipmentGame Equipment (STICKS and PUCKS)(STICKS and PUCKS)
●
Protective EquipmentProtective Equipment (HELMET)(HELMET)

MUSCLES IN HOCKEY SKATING

EQUIPMENTEQUIPMENT

AccidentsAccidents
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ConcussionsConcussions
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Collision with OpponentsCollision with Opponents
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Collision with BoardsCollision with Boards
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SticksSticks
●
PucksPucks

PHYSICALPHYSICAL CONTACTCONTACT
E

Physical Contact - Ihysical Contact - I
(Goulet et al, 2016)(Goulet et al, 2016)
TYPES OF BODY CONTACTTYPES OF BODY CONTACT
Trunk, Limb or ObjectTrunk, Limb or Object
PushingPushing
HoldingHolding
SlashingSlashing
TrippingTripping

Physical Contact - IIhysical Contact - II
(Adapted from Goulet et al, 2016)(Adapted from Goulet et al, 2016)
CHARACTERISTICSCHARACTERISTICS MEASUREMENTSMEASUREMENTS
Type of Physical ContactType of Physical Contact Made with TRUNK (Intensity: 1 to 5)Made with TRUNK (Intensity: 1 to 5)
Other Types: Slashing, Holding, Pushing,Other Types: Slashing, Holding, Pushing,
TrippingTripping
WHO provide the Physical ContactWHO provide the Physical Contact DEFENSIVE PLAYERDEFENSIVE PLAYER
OFFENSIVE PLAYEROFFENSIVE PLAYER
PUCK CARRIERPUCK CARRIER
NON PUCK CARRIERNON PUCK CARRIER
INTENSION of the player when doing theINTENSION of the player when doing the
Physical ContactPhysical Contact
DELIBERATEDELIBERATE
NON DELIBERATENON DELIBERATE

Physical Contact - IIIhysical Contact - III
●
ONE SEASON:ONE SEASON: January-March 2009January-March 2009 (YOUTH Ice(YOUTH Ice
Hockey)Hockey)
●
BODY CHEKING:BODY CHEKING: 45 to 86%45 to 86% (Mechanism of Injury)(Mechanism of Injury)
●
Sustainability of the PlayerSustainability of the Player
●
TRUNK:TRUNK: 5610 physical contact5610 physical contact (90,9team-game)(90,9team-game)
●
Other Types:Other Types: 3429 physical contact3429 physical contact (55,3team-game)(55,3team-game)
BODY CONTACTBODY CONTACT ## BODY CHECKINGBODY CHECKING
(Goulet et al, 2016)(Goulet et al, 2016)

CONCUSSIONSCONCUSSIONS
CLICK in VIDEOCLICK in VIDEO - Linesman Concussion- Linesman Concussion
(LaVoi, 2010 ; Greenwell, 2013)(LaVoi, 2010 ; Greenwell, 2013)

Concussions - IConcussions - I
●
CONCUSSION:CONCUSSION: Transmission of Force to the BrainTransmission of Force to the Brain
●
Direct andor Indirect Impact:Direct andor Indirect Impact: Head, Face, Neck orHead, Face, Neck or
elsewhere along the bodyelsewhere along the body
●
HELMETSHELMETS vs.vs. Concussions=Concussions= ??????
●
PROTECTION:PROTECTION: Linear Focal PointLinear Focal Point
●
IMPACTS:IMPACTS: Rotational Acceleration and Linear ForcesRotational Acceleration and Linear Forces
(Izraelski, 2014 ; LaVoi, 2010)(Izraelski, 2014 ; LaVoi, 2010)

Concussions - II- II
●
08 teams – DIVISION I – 1 Season08 teams – DIVISION I – 1 Season – (men's collegiate)– (men's collegiate)
●
TOTAL: 113 injuriesTOTAL: 113 injuries – 23096 athlete-exposure– 23096 athlete-exposure
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65% in Games65% in Games
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Overall Injuries:Overall Injuries: 4,9 per 1000 athlete-exposure4,9 per 1000 athlete-exposure
●
13,8 per 1000 game athlete exposures13,8 per 1000 game athlete exposures andand 2,2 per 10002,2 per 1000
practice athlete exposurepractice athlete exposure
●
Collision with Opponent (32,8%)Collision with Opponent (32,8%) oror Boards (18,6%)Boards (18,6%)
(Flik et al, 2005)(Flik et al, 2005)

Concussions - IIIoncussions - III
●
3-5 year period3-5 year period (2006-2010) - NHL Season(2006-2010) - NHL Season
●
Heads Up ChecklistHeads Up Checklist
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197 medically diagnosed197 medically diagnosed
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88%88% involved Contact with Opponentinvolved Contact with Opponent
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FORWARDS (more concussions)FORWARDS (more concussions) – 95%CI, 60%, p=0,04– 95%CI, 60%, p=0,04
●
First Period (47%)First Period (47%) - p=0,047 (- p=0,047 (second and thirdsecond and third))
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Defensive Zone (45%)Defensive Zone (45%)
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47% in Open Ice47% in Open Ice andand 53% Perimeter53% Perimeter
●
37% players injuries37% players injuries – Contact with– Contact with Boards or GlassBoards or Glass
(Hutchison et al, 2015)(Hutchison et al, 2015)

CConcussions - IVoncussions - IV
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DiagnosisDiagnosis
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ManagementManagement
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Return-to-play ProtocolsReturn-to-play Protocols
(Izraelaski, 2014)(Izraelaski, 2014)

TYPES OF HELMETSTYPES OF HELMETS
●
RR

Eye Injuries - I
●
STICKSSTICKS - most common cause- most common cause
●
Average Injured Eyes –Average Injured Eyes – 13,7 – 15,0% Blinded13,7 – 15,0% Blinded
●
PUCKSPUCKS - high velocities (> 160 kmh)- high velocities (> 160 kmh)
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Visual AcuityVisual Acuity Before and After InjuryBefore and After Injury
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Effects onEffects on Central and Peripheral VisionCentral and Peripheral Vision
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HELMETS:HELMETS: With Display and Without DisplayWith Display and Without Display
●
PlayersPlayers andand GoaltendersGoaltenders
(Adapted from Pashby et al, 1975)(Adapted from Pashby et al, 1975)

Eye Injuries - II
●
Ocular Blunt TraumaOcular Blunt Trauma – 17 year old male– 17 year old male
●
Collision with OpponentCollision with Opponent
●
STICKSTICK travelled under histravelled under his Half-face VisorHalf-face Visor
●
Hyphema, Angle Recession, lens Subluxation andHyphema, Angle Recession, lens Subluxation and
Choroidal Rupture over the MaculaChoroidal Rupture over the Macula
●
Reducing his Vision -Reducing his Vision - PermanentlyPermanently
●
Safety EquipmentSafety Equipment
●
Full-face ProtectionFull-face Protection
(Morris, 2009)(Morris, 2009)

FACIAL INJURIESFACIAL INJURIES
t

Facial Injuries - I
●
Full Facial Protector (FFP)Full Facial Protector (FFP) vs.vs. Half Facial ProtectorHalf Facial Protector
(HFP)(HFP)
●
Facial Injuries and LacerationsFacial Injuries and Lacerations
●
FFP (p<0,05)FFP (p<0,05)
●
FFP – Relative Risk (RR):FFP – Relative Risk (RR): 2,31, CI: 1,53 to 3,482,31, CI: 1,53 to 3,48
●
FFPFFP - Return to Training and Games- Return to Training and Games vs.vs. HFP:HFP: 1,71,7
sessions, CI: 1,32 to 2,18sessions, CI: 1,32 to 2,18
(Asplund et al, 2009)(Asplund et al, 2009)

Facial Injuries - II
●
Longitudinal Study:Longitudinal Study: 4 years – NCAA Division I4 years – NCAA Division I
●
TOTAL:TOTAL: 798,5 hours practice798,5 hours practice (163 games)(163 games)
●
16 Facial Lacerations16 Facial Lacerations
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14,9 per 1000 playersgamehours14,9 per 1000 playersgamehours
●
Head and Neck (6,3%)Head and Neck (6,3%)
(LaPrade et al, 1995)(LaPrade et al, 1995)

ACROMIOCLAVICULAR Joint SprainsACROMIOCLAVICULAR Joint Sprains
(McKenney, 2016)(McKenney, 2016)

Acromioclavicular Joint Sprains
●
NCAA –NCAA – Period:Period: 2009-20102009-2010 andand 2014-20152014-2015
●
25 NCAA SPORTS25 NCAA SPORTS
●
TOTAL: 844 AC Joint SprainsTOTAL: 844 AC Joint Sprains (1,72 per 10000 athlete-exposures(1,72 per 10000 athlete-exposures
CAEs)CAEs)
●
Sex-comparable Sports –Sex-comparable Sports – In men was 4,67 times that of womenIn men was 4,67 times that of women
(95% CI, 3,56-6,14)(95% CI, 3,56-6,14)
●
SPORTSSPORTS (soccer, basketball, ice hockey, lacrosse,(soccer, basketball, ice hockey, lacrosse,
baseballsoftball, swimming and diving)baseballsoftball, swimming and diving)
●
Player Contact (54,7%)Player Contact (54,7%) andand Surface Contact (29,0%)Surface Contact (29,0%)
●
HIGH RATE:HIGH RATE: soccer, ice hockey and wrestlingsoccer, ice hockey and wrestling
(Hibberd et al, 2016)(Hibberd et al, 2016)

SPINAL INJURIESSPINAL INJURIES
(LaPrade et al, 2000 ; Elsig, 2006 ; Boyd, 2015)(LaPrade et al, 2000 ; Elsig, 2006 ; Boyd, 2015)

Spinal Injuries - ISpinal Injuries - I
●
Canada and USA-Canada and USA- Period: 1976 – 1983Period: 1976 – 1983
●
TOTAL: 42 injuries –TOTAL: 42 injuries – 34 in Games34 in Games andand 01 in Training01 in Training
(Adapted from(Adapted from Tator & Edmonds, 1984)Tator & Edmonds, 1984)
TYPES OF VERTEBRALTYPES OF VERTEBRAL
INJURIESINJURIES
NUMBER OF INJURIESNUMBER OF INJURIES
FRACTURE – DISLOCATION (burstFRACTURE – DISLOCATION (burst
fractures)fractures)
2727
FRACTUREFRACTURE 0909
DISLOCATIONDISLOCATION 0202
NONENONE 0404

Spinal Injuries - IISpinal Injuries - II
(Adapted from(Adapted from Tator & Edmonds, 1984)Tator & Edmonds, 1984)
SPINE – NEUROLOGICAL INJURIESSPINE – NEUROLOGICAL INJURIES NUMBER OF PLAYERSNUMBER OF PLAYERS
Incomplete Spinal Cord InjuryIncomplete Spinal Cord Injury 1616
Complete Motor Loss, IncompleteComplete Motor Loss, Incomplete
Sensory LossSensory Loss
0505
Incomplete Motor Loss, IncompleteIncomplete Motor Loss, Incomplete
Sensory LossSensory Loss
1010
Incomplete Sensory LossIncomplete Sensory Loss 0101
Complete Spinal Cord InjuryComplete Spinal Cord Injury 1212
Nerve Root InjuryNerve Root Injury 0505
NoneNone 0909

Spinal Injuries - IIISpinal Injuries - III
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Risk of ImpactsRisk of Impacts
●
Player-boards CollisionsPlayer-boards Collisions
●
Player-player CollisionsPlayer-player Collisions
●
Player with thePlayer with the NECK FLEXEDNECK FLEXED (Time of Collision)(Time of Collision)
●
Types of Collision:Types of Collision: TACKLING and BLOCKINGTACKLING and BLOCKING
●
~ 4 case of quadriplegia per year in Canadian hockey~ 4 case of quadriplegia per year in Canadian hockey
●
HelmetHelmet
●
Neck-muscle-conditioningNeck-muscle-conditioning
(Adapted from Tator & Edmonds, 1984)(Adapted from Tator & Edmonds, 1984)

GOALTENDERS INJURIESGOALTENDERS INJURIES
●
WikiHow -WikiHow - CLICK in WEBSITECLICK in WEBSITE
●
CLICK in WEBSITECLICK in WEBSITE

Goaltenders InjuriesGoaltenders Injuries
●
FEMOROACETABULAR IMPINGEMENT (FAI)FEMOROACETABULAR IMPINGEMENT (FAI)
●
Phenomenon PrevalentPhenomenon Prevalent
●
Unique Mechanical PositionsUnique Mechanical Positions
●
Butterfly Technique ***Butterfly Technique ***
●
Surgery: TreatSurgery: Treat SYMPTOMATIC FAISYMPTOMATIC FAI
●
NHL (2006-2010):NHL (2006-2010): Hip and Groin Injuries RatesHip and Groin Injuries Rates (1,84(1,84
per 1000 appearances)per 1000 appearances)
●
Intra-articular HIP Injuries –Intra-articular HIP Injuries – Acetabular LabralAcetabular Labral
(MacIntyre et al, 2015)(MacIntyre et al, 2015)

Musculoskeletal Injuries - IMusculoskeletal Injuries - I
●
Soft TissueSoft Tissue
●
Strains of theStrains of the Hip AdductorHip Adductor
●
Tears in theTears in the Medial Collateral Knee LigamentMedial Collateral Knee Ligament
●
ACLACL strain or minor tearstrain or minor tear
●
Contusions of theContusions of the ThighThigh
●
Inadequate Levels of Strength and FlexibilityInadequate Levels of Strength and Flexibility
(adductors and abductors of the legs)(adductors and abductors of the legs)
●
Muscle Imbalance:Muscle Imbalance: Hamstring QuadricepsHamstring Quadriceps
●
Overuse InjuriesOveruse Injuries
(LaPrade et al, 1994 ; Noyes et al, 1989 ; MacLean,(LaPrade et al, 1994 ; Noyes et al, 1989 ; MacLean, no dateno date))

Musculoskeletal Injuries - IIMusculoskeletal Injuries - II
●
SKATINGSKATING ## RUNNINGRUNNING TechniqueTechnique
●
Wind-up PhaseWind-up Phase
●
Push-off FootPush-off Foot
●
LEG:LEG: EExternally Rotated to Around 60°xternally Rotated to Around 60°
●
ACCELERATION:ACCELERATION: Posterolateral PlanePosterolateral Plane
●
Cross-over StepCross-over Step (Adductors)(Adductors)
●
Adductor:AbductorAdductor:Abductor ratioratio <1:1,25<1:1,25
(Nightingale, 2013)(Nightingale, 2013)

Musculoskeletal Injuries - IIIMusculoskeletal Injuries - III
●
ADDUCTOR MUSCLE STRAINS:ADDUCTOR MUSCLE STRAINS:
(Adapted from(Adapted from Tyler et al,Tyler et al, 20022002))
LEVELLEVEL CHARACTERISTICSCHARACTERISTICS
First-degreeFirst-degree PAIN - minimal loss of strength andPAIN - minimal loss of strength and
minimal restriction of motionminimal restriction of motion
Second-degreeSecond-degree TISSUE DAMAGE - compromisedTISSUE DAMAGE - compromised
the strength of the muscle, but did notthe strength of the muscle, but did not
include complete loss of strength andinclude complete loss of strength and
functionfunction
Third-degreeThird-degree COMPLETE DISRUPTION of the muscle-COMPLETE DISRUPTION of the muscle-
tendon unit, including complete loss oftendon unit, including complete loss of
function of the musclefunction of the muscle

General Injuries - I
●
8-year study – Women's8-year study – Women's
(Adapted from Tuominen et al, 2015)(Adapted from Tuominen et al, 2015)
LocationLocation Injury Rate (IR)Injury Rate (IR)
LOWER BODYLOWER BODY 2,71000 player-games2,71000 player-games
UPPER BODYUPPER BODY 1,41000 player-games1,41000 player-games
HEAD and FACEHEAD and FACE 1,31000 player-games1,31000 player-games
SPINE and TRUNKSPINE and TRUNK 0,91000 player-games0,91000 player-games

General Injuries - II
●
Period: 2006 – 2015:Period: 2006 – 2015: U18 and U20U18 and U20 – World Championship- Male– World Championship- Male
(Adapted from Tuominen et al, 2016)(Adapted from Tuominen et al, 2016)
LocationLocation Injury Rate (IR)Injury Rate (IR)
LOWER BODYLOWER BODY 2,61000 player-games2,61000 player-games
UPPER BODYUPPER BODY 3,21000 player-games3,21000 player-games
SPINE and TRUNKSPINE and TRUNK 1,01000 player-games1,01000 player-games
LACERATION FACIALLACERATION FACIAL 3,61000 player-games3,61000 player-games
BOARD CONTACTBOARD CONTACT 59% of Shoulder Injuries59% of Shoulder Injuries

PATHOLOGIES of the AIRWAYSPATHOLOGIES of the AIRWAYS
(Denisikhina, Kolosnicin & Lukanina, 2013)(Denisikhina, Kolosnicin & Lukanina, 2013)

PATHOLOGIES of the AIRWAYSPATHOLOGIES of the AIRWAYS
● Y

Pathologies of the Airways - IPathologies of the Airways - I
● ICE RINK:
a)a) Thermal Conditions
b)b) Indoor Air Quality
c)c) Thermal Confort
d)d) Airflow Patterns
e)e) Ventilation Performance
● Measured Operating Conditionings: In Game, Training Session,
and Maintenance Situation
● Air Speed, Temperature and Humity Sensors
(Lestinen et al, 2016)

Pathologies of the Airways - IIPathologies of the Airways - II
● Temperature rise: 2°C during the game
● Air Speed: 0,25 – 0,3 ms
● Relative Humity: 30-45%
● Carbon Dioxide: 300 – 500 ppm (during the game)
● Air Movement:
a) Supply Air Temperature
b) Variable Air Flow Rates
c) Retractable Stands
d) Case-dependent
(Lestinen et al, 2016)

Pathologies of the Airways - IIIPathologies of the Airways - III
●
Exercise -Exercise - INCREASE VENTILATION:INCREASE VENTILATION: >200lmin>200lmin
●
Exposure toExposure to COLD AIRCOLD AIR ++ HYPERVENTILATIONHYPERVENTILATION
●
Ice Resurfacing MachinesIce Resurfacing Machines in Indoor Ice Arenas:in Indoor Ice Arenas:
a)a) Carbon OxideCarbon Oxide
b)b) Nitrogen OxideNitrogen Oxide
●
HIGH OCCURRENCE:HIGH OCCURRENCE:
a)a) AsthmaAsthma
b)b) Bronchial HyperresponsivenessBronchial Hyperresponsiveness
(Langdeu et al, 2000 ; Helenius et al, 2004)(Langdeu et al, 2000 ; Helenius et al, 2004)

Pathologies of the Airways - IVPathologies of the Airways - IV
●
ICE RINK:ICE RINK: Cold Air (5-10°C)Cold Air (5-10°C)
●
Air Quality ProblemsAir Quality Problems
●
Cold Air Exposure:Cold Air Exposure: GGranulocytes and Macrophagesranulocytes and Macrophages
●
Increased:Increased: CO, NO and NO2 concentrationsCO, NO and NO2 concentrations
a)a) Asthma OccurrenceAsthma Occurrence
b)b) Bronchial HyperresponsivenessBronchial Hyperresponsiveness
c)c) Exercise-induced BronchospasmExercise-induced Bronchospasm
(Lumme et al, 2003)(Lumme et al, 2003)

Pathologies of the Airways - VPathologies of the Airways - V
●
Abnormalities ofAbnormalities of Airway FunctionAirway Function
●
Cysteinyl Leukotrienes:Cysteinyl Leukotrienes:
a)a) MMucus Productionucus Production
b)b) VVascular Permeabilityascular Permeability
c)c) SSmooth Muscle Contractionmooth Muscle Contraction
d)d) RRecruitment of Inflammatory Cellsecruitment of Inflammatory Cells
(Helenius et al, 2004)(Helenius et al, 2004)

Pathologies of the Airways - VIPathologies of the Airways - VI
(Adapted from Lummen et al, 2003)(Adapted from Lummen et al, 2003)
Ice HockeyIce Hockey
PlayersPlayers
CONTROLCONTROL pp
nn 8888 4747
ATOPYATOPY 52 (58)52 (58) 17 (36)17 (36) 0,0250,025
IncreasedIncreased
bronchialbronchial
responsivenessresponsiveness
21 (24)21 (24) 05 (11)05 (11) 0,0970,097
Current AsthmaCurrent Asthma 13 (15)13 (15) 01 (02)01 (02) 0,0330,033
Total AsthmaTotal Asthma 19 (22)19 (22) 02 (04)02 (04) 0,0110,011

Severity of the Injury - ISeverity of the Injury - I
● Slight Injury (1 to 3 days of absence)
● Mild Injury (3 to 7 days of absence)
● Moderate Injury (8 to 28 days of absence)
● Serious Injury (above 28 days of absence)
(Checchi, 2013)

Severity of the Injury - IISeverity of the Injury - II
●
DURATION of ABSENCE PERIOD:DURATION of ABSENCE PERIOD:
a)a) Trauma SeverityTrauma Severity
b)b) Nature of Injured TissueNature of Injured Tissue
c)c) Intensity CureIntensity Cure
d)d) Age of the AthleteAge of the Athlete
e)e) Treatment and Rehabilitation ParticularitiesTreatment and Rehabilitation Particularities
f)f) Character the Training ActivityCharacter the Training Activity
(Platonov, 2008)(Platonov, 2008)

Injury Prevention - IInjury Prevention - I
EPIDEMIOLOGISTSEPIDEMIOLOGISTS
&&
STATISTICIANSSTATISTICIANS
((Parkkari, Kujala & Kannus, 2001)Parkkari, Kujala & Kannus, 2001)

Injury Prevention - II
●
Identify the IncidenceIdentify the Incidence
●
Identify Risk FactorsIdentify Risk Factors
●
Interventions to Address the Risk FactorsInterventions to Address the Risk Factors
●
Test the Effectiveness of the InterventionTest the Effectiveness of the Intervention
(Tyler et al, 2002)(Tyler et al, 2002)

Injury Prevention - III
●
Injury ProblemsInjury Problems (number, incidence, time trends,(number, incidence, time trends,
severity, consequences, impairments, disabilitiesseverity, consequences, impairments, disabilities
and costs)and costs)
●
Etiology, Risk Factors and Mechanisms of InjuriesEtiology, Risk Factors and Mechanisms of Injuries
●
Preventive Measure or ProgrammePreventive Measure or Programme
●
Assessing the Effectiveness and CostAssessing the Effectiveness and Cost
Effectiveness of the Preventive ActionEffectiveness of the Preventive Action
(Adapted from Parkkari, Kujala & Kannus, 2001)(Adapted from Parkkari, Kujala & Kannus, 2001)

Injury Prevention - IVInjury Prevention - IV
● Anamnesis
● Injury History
● Pre-season Tests

Injury Prevention - VInjury Prevention - V
● Equipments:
a) Helmets
b) Sticks
c) Pucks
d) Ice Skates
● Rules

Existence of Injury - I
1)1) Type of InjuryType of Injury
2)2) EvaluationEvaluation
3)3) TreatmentTreatment

Existence of Injury - II
PRICEPRICE
●
PProtectionrotection
●
RRestest
●
IIcece
●
CCompressionompression
●
EElevationlevation

Evaluation of Injury
●
InspectionInspection
●
Physical ExamPhysical Exam
●
Diagnostic TestingDiagnostic Testing (x-ray, CT scan, MRI(x-ray, CT scan, MRI
andor NVCEMG, etc.)andor NVCEMG, etc.)
(DeFrancesco & Inesta, 2012)(DeFrancesco & Inesta, 2012)

Hierarchy of Control
(Adapted from Vretaros, 2002)(Adapted from Vretaros, 2002)
InjuredInjured
AthleteAthlete
SportsSports
MedicineMedicine
PhysicianPhysician
SportsSports
PhysiotherapistPhysiotherapist
PhysicalPhysical
PreparationPreparation
CoachCoach
Examinations,Examinations,
Diagnostic Evaluation,Diagnostic Evaluation,
Treatment IndicationTreatment Indication
Rehabilitation,Rehabilitation,
Functional ReevaluationFunctional Reevaluation
of the Injured Limbof the Injured Limb
Muscle-functionalMuscle-functional
Adaptation for Sport,Adaptation for Sport,
Specific PhysicalSpecific Physical
ConditioningConditioning

Training and Injury Prevention - ITraining and Injury Prevention - I
●
RR Warm upWarm up
MobilityMobility
Movement LearningMovement Learning
ProprioceptionProprioception
StabilityStability
CORECORE
StrengthStrength
PowerPower

Training and Injury Prevention - II
●
PrehabPrehab
●
HydrationHydration

Training and Injury Prevention - III
●
DEVELOP TECHNIQUES TO:DEVELOP TECHNIQUES TO:
1)1) FALLSFALLS in physical contact with opponents casein physical contact with opponents case
2)2) MUFFLEMUFFLE in physical contact case with boardsin physical contact case with boards
●
EXAMPLE:EXAMPLE:
a)a) Agility TrainingAgility Training in Skating Ringin Skating Ring

Training and Injury Prevention - IV
●
ADDITIONAL THERAPIES:ADDITIONAL THERAPIES:
1)1) PilatesPilates
2)2) YogaYoga
3)3) ChiropracticChiropractic
4)4) RolfingRolfing
5)5) Global Posture ReeducationGlobal Posture Reeducation
6)6) And othersAnd others

Effects & Causes
●
Serious SurgerySerious Surgery and orand or Prolonged ImmobilizationProlonged Immobilization
●
Risk of Permanent DamageRisk of Permanent Damage
●
Time SpentTime Spent andand Financial ResourcesFinancial Resources
●
TreatmentTreatment andorandor RehabilitationRehabilitation
●
Recovery of Systemic Adaptations of BiomotorRecovery of Systemic Adaptations of Biomotor
CapabilitiesCapabilities at the Level of Competitive Trainingat the Level of Competitive Training

Injuries in Ice Hockey

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Injuries in Ice Hockey