Hockey injuries

Hockey is a physically demanding sport, played by well-conditioned athletes skating on sharp steel using large sticks to move a solid, hard object at high speeds over a slick surface. As a result, it almost goes without saying that injuries are part of the game. "It's an extremely physical game", says Dr. Lyman Scott-William Smith, a member of the Association of Professional Team Physicians (PTP) and team physician for the Carolina Hurricanes. "There is a whole constellation of injuries that are common in, if not particular to, hockey -- cuts and bruises, pull and strains and separations and dislocations."

Join Dr. Smith as he discusses the nature of hockey injuries, including a few particular ailments and their common treatments.

What are some of the more common hockey injuries?

Dr. Smith: Hockey is an extremely physical sport. There is a lot of strength involved and there is a lot of speed on a very, very hard surface, not only the ice but on the boards and the plexiglass as well. In addition, there are dangerous areas of the rink, like the posts, that these guys get knocked into. There are sharp skates and swinging sticks in hockey. So there is a constellation of injuries that, while not unique to the game, are certainly more prevalent in hockey. As you would think, most of our daily concerns involve cuts and contusions.

Then you've got a range of injuries that are primarily muscular. Hockey players are constantly twisting and turning, which stresses the upper thigh, abdomen and pelvic areas. They are also suspended on a tiny blade of metal, so there is also a tremendous amount of balance required. This combination of strength and balance leads to a number of groin, abdominal and back pulls and strains. And then there are the injuries that are endemic to almost any sport -- shoulder dislocations, knee injuries, etc.

Are there any injuries that are particular to hockey?

Dr. Smith: While not unique to hockey in particular, two common injuries are shoulder problems such as acromio-clavicular (AC) joint injuries and shoulder dislocations, and MCL injuries to the knee. There are also a whole variety of other injuries that we typically don't have to deal with in North Carolina, things particular to cold environments like cold and flu ailments, fever blisters on the lip and bitten tongues. These guys are kind of like ballerinas in that they make their living on their feet. What you and I may see as an insignificant foot problem can be just critical for these guys. They get serious blisters from breaking in new skates.

Another thing hockey players have to deal with is that small projectile called the puck that is going up to a 100 miles an hour. In fact, many contusions and broken bones come from getting hit with the puck, especially in the foot and lower leg. Another particular category of injury comes from the blade on the bottom of their skate. It is very, very sharp. Hockey players can sustain some very bad cuts on the ice -- I've had to do some really serious surgery at the rink on players slashed by the blade of a skate.

Do the types of hockey injuries change over the course of a season?

Dr. Smith: I would say there is a general trend rather than a true progression. We tend to see more of the muscle strains in the beginning, more of the contusions in training camp because players are banging around for jobs and the rookies are trying to make name for themselves. As the year progresses, these tend to reach a steady state, if you will. As the year goes on you tend to see more fatigue injuries like tendinitis and pulled muscles because players are asking so much of themselves that they can overdo it. Fatigue does play a large role as this is an extremely aerobic sport. And it's a long season.

What are the common treatments for these ailments?

Dr. Smith: As physicians, we want to take all the credit, but the reality is that we let Mother Nature do most of the work in the majority of the cases. Every team has a trainer and therapist associated with it, so we get them involved quickly on an injury. When it comes to a contusion or a broken bone, there really isn't a lot you can do other than immobilize it, ice it and allow Mother Nature to take over. When it comes to shoulder dislocations and knee ligament injuries, we try to brace people or use various forms of protection. We are much more aggressive than 10 to 15 years ago in getting these guys back. We used to let things rest and heal and then work on strengthening, but today we go ahead and exercise them to maintain the motion and strength even in the healing process.

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How is the prognosis?

Dr. Smith: The vast majority of the time they come back depending on the injury. We had a case when someone on our team blew his knee out and that is obviously a longer process, about three to six months of rehabilitation. But one of the problems is that hockey is so skill-specific and the level that the players reach is so fine-tuned that a short-term injury is much more devastating to a hockey player in that he can quickly lose his skating and stick handling skills and aerobic fitness. These skills take a tremendous amount of practice to evolve and perfect and a certain amount of time to reacquire.

Is there any way to prevent certain hockey injuries?

Dr. Smith: The biggest thing we try to do is make sure that these guys stay in a very good strengthening and stretching program in the off-season. No longer is the off-season a vacation -- it's part of a year-round strengthening and conditioning program. That has become an integral part of the sport and coaches and management are very much keyed into that today. If you have a guy who comes into camp overweight and out of shape, that is a good sign that you may have an athlete who is going to have problems with injuries.

I also think that there is a lot of work being done to convince the players, the players association and the league itself to get involved with preventive-type things such as helmets. If you look at a hockey helmet compared to a football helmet, there is a world of difference and, I think, a tremendous opportunity for the health of the players to be improved. As you may know, concussions were really rampant when the players were allowed to hit a little more. That has fortunately been cut back. I would also love to see a protective cage or visor on the helmet. I think there are way too many facial injuries that are preventable. A lot of guys will complain that visors will change their vision and ability to play the game, but I'm not so sure that those complaints aren't just based on tradition and convenience more than anything else. Hockey players have lost eyes and had to quit the game. That is a terrible injury and can possibly be preventable in the future.

Dr. Lyman Scott-William Smith, a member of the Association of Professional Team Physicians (PTP), is the team physician for the Carolina Hurricanes. Dr. Smith received his undergraduate degree and medical degrees from Duke University in Durham, North Carolina. Dr. Smith completed his internship and residency at the University of Virginia and his fellowship at the American Sports Medicine Institute in Birmingham, Ala. He is presently is associated with the Raleigh Orthopaedic Clinic in Raleigh, North Carolina.

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