Youth Ice Hockey Injuries

There are few sports with the same unique physical demands as youth ice hockey.   Brendan Shanahan explained it this way when asked by a reporter “Is hockey hard?”

“Is hockey hard? I don’t know, you tell me. We need to have the strength and power of a football player, the stamina of a marathon runner, and the concentration of a brain surgeon. But we need to put all this together while moving at high speeds on a cold and slippery surface while 5 other guys use clubs to try and kill us. Oh yeah, did I mention that this whole time we’re standing on blades 1/8 of an inch thick? Is ice hockey hard? I don’t know, you tell me. Next question.”

From this quote alone you could have guessed that many of the injuries sustained playing ice hockey are contact injuries.  Not surprisingly, the majority of injuries occur due to contact with another player, the boards, or attempting to block a shot.  Many of these factors are not modifiable and certain risk factors have been associated with increased risk of contact injury.  Thankfully, hockey initiatives have led to decreased contact injuries in youth leagues.  Other things that can be done to reduce the chances of sustaining an injury due to contact in youth ice hockey include

  • Avoiding early sport specialization.
  • Ensure adequate nutrition and rest. Athletes who rated themselves as having low energy levels or higher levels of fatigue had higher rates of injury in high school ice hockey.
  • Practice matters! Athletes who had much higher time spent in games compared to practice had higher levels of injury.
  • Strength and conditioning. Athletes with lower body weight tend to have higher injury rates.  Youth athletes may be physically immature and compete against individuals who are significantly more physically developed than them.

Overuse Injuries of the Hip in Youth Ice Hockey

Another unique demand of hockey is the amount of range of motion required throughout the hip joint and the muscular control needed in what would typically be considered awkward positions.  The hockey stride is a repetitive motion alternating between repetitive hip flexion and internal rotation followed by hip extension, abduction and external rotation. Running only requires small amounts of hip flexion and hip extension without any movement in the other planes of motion.  These unique requirements lead to hip injuries that are more prevalent in hockey players.

Many of the non contact injuries acquired in youth hockey are at the hip joint.  They typically include groin strains or sports hernias and bony injuries around the hip joint. Luckily there are some things that can be done to help reduce non contact hip injuries for kids playing ice hockey.

Early Sports Specialization & Youth Hockey Injuries

As described above, avoiding early sport specialization is important to minimize injury risk.  There is a great deal of stress placed on the hip through repetitive skating.   Therefore, avoiding year round skating while the athlete is still growing may help reduce the incidence of growth plate injuries and other bony abnormalities.  Taking time off from one sport to learn new motor skills and athletic abilities will ultimately translate to improved performance and reduce the chance of an overuse injury at the hip.  A strength and conditioning or prehabilitation program designed at improving hip and core muscular strength and endurance as well as hip mobility specific to the demands of hockey can help reduce injury.

Conclusion

Hip and groin pain can be very challenging and limiting for athletes and often becomes a recurrent injury.  It can be difficult to distinguish between sports hernias, adductor strains, or bony injuries within the hip joint itself. If you are experiencing hip pain, see a rehabilitation expert who can help you treat this pain and improve your performance.

References

  1. Smith AM, Stuart MJ, Wiese-Bjornstal DM et al. Predictors of injury in ice hockey players. A multivariate, multidisciplinary approach. Am J Sports Med 1997;25:500–7.
  2. Popkin CA, Schulz BM, Park CN, Bottiglieri TS, Lynch TS. Evaluation, management and prevention of lower extremity youth ice hockey injuries. Open Access J Sports Med. 2016;7:167–176.

 

 

Early Sport Specialization and Long-Term Athletic Success

Sport specialization is defined as year-round (≥8 months per year) intensive training in a single sport at the exclusion of other sports.   Early sport specialization refers to those who focus on a single sport before entering high school.  Advocates for early specialization propose that athletic performance in that sport will be better than the performance of those who play multiple sports.  These beliefs became popularized after several recently published best-selling books proposed a “10,000 hour rule” of practice for developing expertise in any given skill or sport.

The effectiveness of increasing the amount of early exposure to a single sport on athletic performance is questionable.  In fact recent research suggests those youth athletes who participate in multiple sports and delay specialization are at an advantage over those who specialize.  The long-term athletic development (LTAD) model provides a structured framework where youth athletes participate in multiple sports in order to maximize their full athletic potential over the lifespan.  Emerging research supports multiple sports participation and the LTAD model as methods to reduce injury risk and maximize athletic potential through high school, college, and beyond.

Early Sport Specialization & High School Athletics

Present day athletes are specializing in a single sport earlier than previous generations.  One recent study showed current high school athletes specialize at an average age of 13 years old.  Current collegiate athletes specialized at an average age of 15 years old.  High school athletes who specialize in one sport for more than 8 months of the year are 2 to 3 times more likely to suffer a lower body overuse injury.  Athletes who engage in baseball for more than 8 months per year are more likely to develop overuse arm injuries.  The repetitive nature of engaging in a single sport predisposes youth athletes to chronic injuries which will likely impact their career beyond high school.  Also, there is currently no evidence which suggests athletes who specialize in a single high school sport are more successful performers than multisport athletes.

Early Sport Specialization & Collegiate Athletics

A survey of Division I college athletes showed 16% specialized in 9th grade and 41% specialized in 12th grade.  This suggests the majority of NCAA Division I athletes were late to specialize in their chosen sport.  Therefore, early specialization does not appear to be necessary in order to succeed at the collegiate level.   Other research found college basketball players who specialized late in their playing career developed their skills and performance to a greater level than those who specialized early.    Several Division I college coaches have gone on record to state their preference for recruiting multisport college athletes.  Athletes who participate in multiple sports possess superior fundamental movement skills and are generally more “coachable” than single sport athletes.

Early Sport Specialization & Professional Sports

Professional athletes are now advocating for multiple sport participation in today’s youth.  Sixty-three percent of surveyed professional baseball players believe early sport specialization is not required to play professionally.  Only twenty-two percent of professional athletes from multiple sports would want their own child to specialize in 1 sport during childhood

NBA players who played multiple sports in high school participate in more professional basketball games throughout their career compared to those who specialized early.  These same NBA players who played in more games were less likely to suffer an injury compared to those who specialized early.  Also, those NBA players who specialize late demonstrate greater longevity in the league.

Approximately half of present day MLB players specialized prior to high school.  Those who specialized early sustain more serious injuries during their professional career compared to those who specialize late.   Youth baseball players should be encouraged not to participate in a single sport given the increased incidence of serious injuries later in their careers. To date no research suggests that early specialization is needed to reach the professional level of any team sport.

Closing Thoughts

Parents and coaches should encourage youth athletes to delay sport specialization as late as possible.  Athletes who specialize late are at least as likely to compete at high levels (college and professionally) as those who specialize early.  Also, those  who delay specialization are less likely to sustain injuries and more likely to achieve long-term success at the professional level.   Most importantly, encouraging multiple sports participation promotes long-term enjoyment of sport which will build health and fitness habits for a lifetime.

References

  1. Bell DR, Post EG, Trigsted SM, Hetzel S, Mcguine TA, Brooks MA. Prevalence of sport specialization in high school athletics: A 1-year observational study. Am J Sports Med. 2016;44(6):1469-1474. doi:10.1177/0363546516629943.
  2. Buckley PS, Bishop M, Kane P, et al. Early single-sport specialization and professional athletes. Orthop J Sport Med. 2017;5(7):1-7. doi:10.1177/2325967117703944.
  3. Post EG, Thein-Nissenbaum JM, Stiffler MR, Brooks MA, Bell DR. High school sport specialization patterns of current division I athletes. Sport Heal A Multidiscip Approach. 2016;XX(x):1-6. doi:10.1177/1941738116675455.
  4. Santos S, Mateus N, Sampaio J, et al. Do previous sports experiences influence the effect of an enrichment programme in basketball skills? J Sports Sci. 2017;35(17):1759-1767. doi:10.1080/02640414.2016.1236206.
  5. Wilhelm A, Choi C, Deitch J. Early sport specialization effectiveness and risk of injury in professional baseball players. Orthop J Sport Med. 2017;9:1-5. doi:10.1177/2325967117728922.

 

Resistance Training Reduces Injury in Youth Athletes

In our last article, we discussed the safety of youth resistance training. In addition to being safe for youth athletes, resistance training can also reduce injury and improve athletic performance. Resistance training has been shown to reduce injuries in adolescents who participate in football, soccer, basketball, and various other sports1-2. Adolescent females are especially vulnerable to knee injuries. Preseason conditioning programs that include plyometric training, resistance training, and jump training significantly reduce knee injuries in female athletes. Also, youth athletes who engage in regular resistance training recover quicker from injuries when they do occur.

When to Incorporate Resistance Training for Children

Youth athletes can benefit from developing fundamental movement skills (e.g., jumping, landing, and throwing) through appropriate fitness conditioning at early ages (6-10 years old). Once fundamental movement skills are mastered, appropriately supervised strength training programs can be initiated to reduce the likelihood of overuse injuries occurring during sport. Resistance training addressing specific risk factors associated with youth-sport injuries (e.g., low fitness, muscle imbalances, and training errors) reduce overuse injuries by as much as 50%1, 3. With early exposure to resistance training, young athletes may be able to prevent the development of deficits which predispose them to injury later in life.

Resistance Training for Youth Non-Athletes

Free-time physical activity among children and adolescents is on the decline. Strength training is beneficial for athletes and children who are not engaged in competitive sports. Physical inactivity is a risk factor for activity-related injuries in children. Youth who participate regularly in age-appropriate fitness programs, which include resistance training, may be less likely to suffer an injury.

Conclusion

Although the total elimination of injuries is unrealistic, appropriately designed conditioning programs that include strength training can help reduce the likelihood of sports- related injuries.  Clearly, incorporating resistance training supervised by qualified professionals is in the best interest of any young athlete looking to minimize risk for injury and improve performance. Our next article will discuss the role of resistance training for improving athletic performance.

References

  1. Faigenbaum, A., Kraemer, W., Blimkie, C., Jeffreys, I., Micheli, L., Nitka, M., & Rowland, T. (2009). Youth resistance training: Updated position statement paper from the National Strength and Conditioning Association. Journal of Strength and Conditioning Research, 23(5), S60–S79.
  2. Faigenbaum, A. D., & Myer, G. D. (2010). Resistance training among young athletes: safety, efficacy and injury prevention effects. British Journal of Sports Medicine, 44, 56–63. http://doi.org/10.1136/bjsm.2009.068098
  3. Lloyd, R. S., Faigenbaum, A. D., Stone, M. H., Oliver, J. L., Jeffreys, I., Moody, J. A., … Myer, G. D. (2014). Position statement on youth resistance training: The 2014 international consensus. British Journal of Sports Medicine, 48, 498–505. http://doi.org/10.1136/bjsports-2013-092952

Is it Safe for Children to Do Strength Training?

There is substantial interest and lingering concern from parents, coaches, and the medical community about the safety and appropriateness of strength training for children.   Are these concerns based on solid research or are they misconceptions which need to be put to rest?

What is Resistance Training?

Before discussing the evidence, clear definitions of the terms children and resistance (or strength) training are helpful. Resistance training is a specialized form of conditioning whereby an individual is working against a wide range of resistive loads to enhance health, fitness, and performance. Forms of resistance training include the use of body weight, weight machines, free weights (barbells and dumbbells), elastic bands and medicine balls. Resistance training should be distinguished from terms such as weightlifting and bodybuilding. The term children refers to girls and boys (generally up to the age of 11 and 13 years, respectively) prior to puberty and have not developed secondary sex characteristics.

Injury Rates in Children

With qualified supervision, the risk of injury from resistance training for children is very low. Faigenbaum and Myer (2010) summarized over 30 studies conducted on youth resistance training and found reports of only three injuries when properly supervised. The three injuries reported were short-term non-serious injuries such as muscle strains and low back pain. In fact, the estimated risk for injury from youth resistance training has been estimated to be 0.05 to 0.17 for every 100 hours of training. These injuries rates are far lower than those for children engaging in sports such as soccer, football, baseball, gymnastics, lacrosse, and running. Youth injury rates from resistance training are also believed to be no different than those of adults.

Growth Plate Injuries


The most often cited concern associated with youth resistance training is the potential for injury to the growth plate and “stunted growth”. There have been a few retrospective case reports describing injuries to the growth plates in children.  However, most of these injuries were caused by improper lifting technique, poorly chosen loads, or a lack of qualified adult supervision. For example, in one case report a 13-year-old boy sustained elbow growth plate fractures when he lost control of a 65-pound barbell he attempted to press overhead exercising alone at home.

Injury to growth plates has not been reported in any prospective youth resistance training study that provided professional supervision and instruction. There is also no evidence that resistance training can negatively impact growth in height during childhood. The risk of growth plate injury is likely greater when children perform jumping and landing activities during competitive sports or even free play.

Conclusion

Many of the forces that youth are exposed to in sports and recreation (e.g., soccer, basketball, football, and running) are greater both in duration and magnitude than properly performed resistance training. However, problems can, and often do arise, when children are introduced to resistance training with inappropriate instruction or supervision. With the increasing volume and intensity of youth sports, it is more important than ever that children are properly instructed, supervised, and progressed by qualified personnel. Therefore, parents and coaches should seek out qualified professionals who are knowledgeable and up to date with the most current evidence about youth resistance training. When appropriately performed, youth resistance training is safe and extremely beneficial for improving health, fitness, and performance.

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References

  1. Faigenbaum, A., Kraemer, W., Blimkie, C., Jeffreys, I., Micheli, L., Nitka, M., & Rowland, T. (2009). Youth resistance training: Updated position statement paper from the National Strength and Conditioning Association. Journal of Strength and Conditioning Research, 23(5), S60–S79.
  2. Faigenbaum, A. D., & Myer, G. D. (2010). Resistance training among young athletes: safety, efficacy and injury prevention effects. British Journal of Sports Medicine, 44, 56–63. http://doi.org/10.1136/bjsm.2009.068098
  3. Lloyd, R. S., Faigenbaum, A. D., Stone, M. H., Oliver, J. L., Jeffreys, I., Moody, J. A., … Myer, G. D. (2014). Position statement on youth resistance training: The 2014 international consensus. British Journal of Sports Medicine, 48, 498–505. http://doi.org/10.1136/bjsports-2013-092952

Dangers of Athletic Practices in the Heat

Pre-season sport practices will be kicking off over the next few weeks. With the excitement of another season fueling summer practices, comes the dangers of playing in hot and humid conditions. There are three forms of exertional heat illness which players, parents, and coaches should be familiar with. These are heat cramps, heat exhaustion, and heatstroke. For more about what exertional heat illness is and is not, read here.

Three Forms of Exertional Heat Illness

Heat cramps are the least serious and typically involve painful cramping of large muscles (commonly the calf muscles). Heat cramps are caused by sodium loss and dehydration which accompany high rates of sweating. Treatment of heat cramps involves moving the athlete to a cooler environment and administering fluids such as sodium containing sports drinks. Prevention strategies include remaining hydrated during practices and liberal use of sodium containing foods or beverages.

Heat exhaustion is a more serious disorder characterized by fatigue, dizziness, nausea, vomiting, fainting, and a weak, rapid pulse. In such cases, the body’s cardiovascular system is unable to meet the needs of the body as it becomes dehydrated. The underlying cause is dehydration caused by fluid loss from sweating. Athletes who are unfit or not acclimated to the heat are more susceptible. Treatment involves resting in a cool environment with the feet elevated to facilitate blood return to the heart. Administration of fluids (water or a sodium containing beverage) is also recommended.

Heatstroke is a life-threatening disorder requiring immediate medical attention. It is caused by an inability to control core body temperature. A core body temperature exceeding 104 degrees, confusion, disorientation, and unconsciousness are hallmark signs. If left untreated, body temperature will continue to rise progressing to coma and even death. Rapid cooling of the body in an ice bath is the best form of treatment. If cold-water immersion is unavailable the athlete should be wrapped in cold wet sheets while others fan the body.

Impact of Humidity

High humidity means the air contains many water molecules. In these instances, the air cannot accept much more water. During exercise in the heat, excessive body heat is lost through evaporation of sweat at the surface of the skin. If humidity is high, sweating will be much less effective in releasing body heat because evaporation is inhibited. Even though sweat secretion will continue during the exercise bout, without evaporation the rate of core body temperature may continue to rise. Therefore, high humidity increases the likelihood of experiencing any of the three forms of exertional heat illness.

Preventative Steps

Athletes can take preventative steps to minimize the detrimental effects of playing in hot environments. Strategies which promote heat adaptation have been shown to assist with an athlete’s ability to tolerate and perform in hot and humid environments. Adaptation requires a series of gradual progressively increasing temperatures in order to produce sufficient adaptations. Longer and more frequent heat exposures produce heat adaptation benefits resulting in the greatest capacity and performance benefits. Regimens lasting more than 14 days show the greatest benefits.

Coaches and parents should take preventative steps when threatening conditions are present. Practices in the early morning or evening can avoid the severe heat stress of midday. Fluids should be available and athletes should be given drink breaks every 15 to 30 minutes. Weighing athletes before and after exercise can help estimate individual sweat rate and fluid needs. Fluids containing electrolytes and carbohydrate can provide benefits over water alone. Light colored, lightweight, loose-fitting clothing should be worn whenever possible. And finally, heavy use of equipment (i.e., football pads and helmets) should be minimized or avoided early in the practice season when athletes are not yet fit or acclimated to the heat.

References

  1. Bergeron, M. F., Bahr, R., Bärtsch, P., Bourdon, L., Calbet, J. A. L., Carlsen, K. H., … Millet, G. (2012). International Olympic Committee consensus statement on thermoregulatory and altitude challenges for high-level athletes. British Journal of Sports Medicine, 46, 770–779. http://doi.org/10.1136/bjsports-2012-091296
  2. Kenney, W. L., Wilmore, J., & Costill, D. (2015). Physiology of sport and exercise (6th ed.). Champaign, IL: Human Kinetics.
  3. Tyler, C. J., Reeve, T., Hodges, G. J., & Cheung, S. S., (2016). The effects of heat adaptation on physiology, perception and exercise performance in the heat: A meta-analysis. Sports Medicine, 46(11), 1699–1724. http://doi.org/10.1007/s40279-016-0538-5