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Injury prevention for female field hockey players sport coaching pedagogy
- 1. INJURY PREVENTION FOR FEMALE FIELD Niina Flaherty HOCKEY PLAYERS
- 2. MOST COMMON INJURIES 70 Lower limb Back Pain (ankle sprain, muscle 60 strain) % of reported injury 50 Ankle 40 sprains Impact Head/Face 30 Traumas (impact traumas and concussions) 20 Muscle Concussions Back Pain strains Reported as 10 Injury Lower back (pain) 0 Lower Limb Head/Face Back Pain Mur taugh, K. (2001). Injur y patterns Area of Injury among female field hockey player s. Figure 1. Graph illustrating injury sustained Medicine & Science in Spor ts & E x e r c i s e , 3 3 ( 2 ) , 2 0 1 - 2 07. by female hockey players as a percentage of the whole
- 3. LOWER LIMB INJURIES Ankle sprain • Most reported • Stretched beyond capacity • Ligament tear Muscle strain • Stretched beyond capacity • Muscle tear • M u r t a ug h , K . ( 2 0 01 ) . I n j u r y p a t te r n s a m o n g Ortiz, L.O. (2010) Australia vs Nueva Zelanda. f e m a l e f i e l d h o c key p l aye r s . M e d i c i n e & Flickr, http://www.flickr.com/photos/loviedo/49625202 S c i e n c e i n S p o r t s & E xe r c i s e , 3 3 ( 2 ) , 2 01 - 16/ 2 07.
- 4. PREVENTION OF ANKLE SPRAINS B a l a nc e B o a rds • Decrease ankle sprain reoccurrence • N o c h a n g e i n t h o s e w h o h av e n ot p r e v i o u s l y suffered ankle sprain • I n c r e a s e r i s k o f k n e e ov e r u s e i n j u r y • Verhagen, E., Van Der Beek, A., Twisk, J., Bouter, L., Bahr, R., & Van Mechelen, W. (2004). The effect of a proprioceptive balance board training program for the prevention of ankle sprains a prospective controlled trial. The American journal of sports medicine, 32(6), 1385-1393. • H i g h -top s h o e s a n d pro phy l a c t i c a n k l e t a pi n g • Decrease ankle sprain • No shown increase in knee injur y • Should be considered Nicholson, J. (2008) Fonkle Day 2. Flickr. • Garrick, J. G., & Requa, R. K. (1973). Role of external support in the prevention of http://www.flickr.com/photos/jnicho02/2609505015/in/photostream/ ankle sprains. Med Sci Sports, 5(3), 200-203.
- 5. MUSCLE STRAIN PREVENTION Dielis, J. (2012) Stretched. Flickr http://www.flickr.com/photos /dielis/7210081150/ Flexibility training • Wi de l y us e d a n d a c c e pte d • I n c o n c lusive – n ot prove n • Curre n t l y dy n a m ic pre - g a m e/t raining , s t a t i c po s t - g a m e/t raining Eccentric strength training • Arnason, A., Andersen, T. E., Holme, I., Engebretsen, L., & • Re duc t i o n i n te a r s Bahr, R. (2008). Prevention of hamstring strains in elite soccer: an intervention study. Scandinavian journal of medicine & science in sports, 18(1), 40-48. Stretching
- 6. HEAD/FACE INJURIES Non-concussed Impact traumas • Bruise/Black eye • Wound • Broken nose Concussions • Traumatic brain injur y • If repeated increase the risk of dementia, Parkinson’s disease and depression • M u r t a u g h , K . ( 2 0 01 ) . I n j u r y p a t t e r n s a m o n g f e m a l e fi e l d h o c key p l aye r s . Medicine & Science in Sports & E xe r c i s e , 3 3 ( 2 ) , 2 01 - 2 07. Henry, L. (2007) my brains – let me show you them Flickr http://www.flickr.com/photos/lizhenry/2051224366/
- 7. PREVENTING HEAD INJURIES Commonly occur in the circle • Rule change • Change of game style Danger Zones • Protective gear on short corners D i c k , R . , H o ot m a n , J . M . , A g e l , J . , Ve l a , L . , M a r s h a l l , S . W. , & M e s s i n a , R . ( 2 0 07 ) . D e s c r i p t i v e e p i d e m i o l o g y o f c o l l e g i a t e wo m e n ' s fi e l d h o c key i n j u r i e s : N a t i o n a l C o l l e g i a t e Athletic Association Injur y Sur veillance S y s te m , 1 9 8 8 – 1 9 8 9 t h r o u g h 2 0 0 2 – 2 0 0 3 . J o u r n a l o f a t h l et i c t r a i n i n g , 4 2 ( 2 ) , 21 1 .
- 8. LOWER BACK PAIN Injury? • Is it just accepted? • Bent over for long periods • Twisting frequently • Mobility issues later in life • Mur taugh, K. (2001). Injur y patterns among female field hockey player s. Medicine & Emily (2008) My freakin’ back #1 Flickr Science in Spor ts & Exercise , 33(2), 201- http://www.flickr.com/photos/emilyhigginson/28 2 0 7. 84127732/
- 9. LOWER BACK PAIN PREVENTION Bend at your knees and hips Straight back Ligamentous Laxity – Increases risk Appropriate cool -down Nadler, S. F., Wu, K. D., Galski, T., & Feinberg, J. H. (1998). Low back pain in college athletes: a prospective study correlating lower extremity overuse or acquired ligamentous laxity with low back pain. Spine, 23(7), 828-833. Krivickas, L. S., & Feinberg, J. H. (1996). Lower extremity injuries in college athletes: relation between ligamentous laxity and lower extremity muscle tightness. Archives of Shanks, P. (2009) low flying hockey player Flickr physical medicine and http://www.flickr.com/photos/botheredbybees/39 rehabilitation, 77(11), 1139-1143. 73065791/
- 10. NOTES FOR THE COACH Strapping of ankles to avoid injury, especially if injury has occurred previously Eccentric exercise to prevent muscle strains Appropriate safety protection warn (face guards in short corners) Game tactics to spread out to prevent injuries caused by overcrowding Dynamic warm-up and static cool-down (with a walk) Encourage players to talk about injuries, stay informed
Editor's Notes
- Field hockey could be considered to be a reasonably dangerous game. Although not defined as a contact sport, contact is often made. Additionally to this players are equipped with hard implements and injury often occurs. It is important for coaches to look at ways to prevent these injuries for the safety of their players.
- According to a study conducted by Karen Murtaugh in 2001, the most frequently injured areas are the lower limbs, and the head or face, with 51 and 34% of reported injuries respectively. 66% of reported lower limb injuries were ankle sprains, followed by muscle strains at 16%. Whilst not necessarily serious for health, lower limb injuries such as these are limiting for the players lifestyle and should be managed. 77% of head and face injuries were impact traumas without concussion, including black eyes, bruises, wounds and broken noses. 22% were concussions. Head injuries are extremely dangerous for the athlete and need to be limited wherever possible. 59% of female hockey players surveyed reported back pain at some point during the season, the most common area sited was the lower back. However, despite experiencing back pain, players did not report it as an injury. Back pain could lead to more serious mobility issues later in life and is important to prevent when able.
- Ankle sprains were the most reported injury of all the hockey players surveyed. A sprain occurs when a joint is stretched beyond its capacity and a tear forms in the ligament. This can be a complete or partial tear. More often than not the tear is partial and will require rest, ice, compression, elevation and seeing a professional. 1-6 weeks is the expected recovery time depending on the severity of the tear. For a complete tear, surgery may be necessary and could require months to heal. Like sprains, muscle strains appear when a muscle is stretched over its normal capacity and a tear forms. Again like sprains the strains can range from partial tears to complete ruptures and treatments are similar. Both of these reduce activity time, and prevention where possible is important.
- Ankle sprains are common in many sports where direction change is necessary. Balance boards have been suggested as a way to strengthen the stabilisers around the ankle, another option is external stabilisers such as high topped shoes or prophylactic ankle taping. Balance boards have been shown to decrease the reoccurrence of ankle sprain, however for individuals who have not yet suffered a sprain no proven benefit has been shown. Unfortunately balance boards have been connected with a higher rate of knee overuse injuries, so it is recommended that even though they may be of use for rehabilitation of ankle sprains that they are not used as a preventative measure otherwise. High-top shoes and prophylactic ankle taping on the other hand have been shown to decrease ankle sprains for both previously injured and non-injured individuals and have also not been shown to have the same negative impact on the knees. These would be useful preventative measures for the coach to discuss.
- Flexibility training has not been proven to reduce the incidence of muscle strain. What has shown some benefits is eccentric strength training. These are exercises where the body has to utilise muscles whilst lengthening them, incorporating these exercises would be of benefit. Stretching, warm-ups and cool-downs, have been around for years. Most recently it has been shown that dynamic stretching or a moving warm up is best pre-game as it prepares the muscles without releasing their elastic energy. Post match stretching may be static stretching combined with a walk. These should be performed pre and post every training session or game.
- All head and face injuries in the Murtaugh study were caused by impact, whether by the ball, a stick, another player or even the ground. Most did not cause concussion and mainly resulted in bruising and black eyes, wounds (such as split eyebrows), and broken noses. The 22% that resulted in concussion are more troubling and undoubtedly need to be prevented wherever possible. Concussions are mild brain trauma and whilst one may not be serious, repeated concussions can increase the risk of dementia, Parkinson’s disease and depression.
- The study by Dick et al in 2007, highlighted the 25 yard line (the area coloured in blue) as the most dangerous area on the field for head injuries with 71% occurring within this region. Since this study the rules have now been changed to attempt to decrease these statistics. The rules now state that when within the 25 yard line, you cannot hit the ball directly into the circle, which may prevent some of the crowding as well as the direct hits into crowded space. A change in the style of game is also recommended, aiming to spread the players away from one another to decrease injury by crowding. The third change coming in applies to short corners, a video is linked as an example. Progressively more players are wearing protective face gear in this situation which should be encouraged by all coaches.
- Many hockey players experience back pain, especially those just starting out. When I started it was just expected that I would have some amount of back pain, so I can understand why it would be under reported. It’s quite an unnatural position to be in. With hockey you are bent over for long periods at a time, and if you haven’t got the correct body position you will get pain. Along with being bent over, your body is frequently twisted with every pass you make. I believe the expectation accounts for the difference between those that experienced back pain (59%) and those that reported it as an injury (1%). If back pain is consistent and ignored it could lead to mobility issues later in life, so something does need to be done about it.
- To prevent lower back pain the stance most hockey players take it with their knees very bent, and their hips very bent and keeping their back as straight as possible. If back pain is still present with this stance, it may be due to over tightening of your muscles and lengthening of your ligaments (called ligamentous laxity). To prevent over tightening of the muscles, and therefore to prevent lower back pain, it is important to always have an appropriate cool-down in place.
- To prevent injury coaches should:Encourage strapping of ankles, especially when injury has occurred previouslyAdd eccentric strength exercises into fitness sessions to prevent muscle strainsAlways ensure that appropriate safety protection is warn, with the most recent addition of the face guard in short cornersTry to drive your game tactics toward making space as it will prevent some of the overcrowding injuries that could occurMake sure your team participates in a dynamic warm up, and a static cool-down with a walkMost importantly, make sure you’re informed of any injuries present in the team, encourage players to tell you about injuries, and make sure you know what is appropriate for those injuries.