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.

 

Baseball Stretching Drill to Restore Range of Motion between Innings

Baseball players will lose range of motion in their throwing shoulder and elbow following a pitching session.  This loss of range of motion becomes cumulative over the course of a season.   Range of motion deficits have been shown to increase the risk of arm injury in baseball players.  Baseball stretching routines performed over the course of a season can help reduce this risk.  Also, stretching drills during baseball games, or between innings, is another method to combat muscle tightness and loss of range of motion in baseball pitchers.

The two-out drill has been developed by researchers from the California State University in Sacramento, and world-renowned orthopaedic surgeon Dr. James Andrews.   These seven baseball stretching exercises can be performed in approximately one minute between innings.  During game situations, the drill is initiated after two outs have been recorded and prior to the pitcher taking the mound each inning.   Performing this drill has been shown to restore professional baseball pitchers shoulder range of motion back to pre-pitching levels.   The seven baseball stretching exercises are described below with a video to follow.

Baseball Stretching: The Two-Out Drill

  1. Internal rotation stretch. Place the non-throwing hand on top of the throwing elbow with the non- throwing forearm resting on top of the throwing forearm. The non-throwing arm is then used to produce an internal rotation stretch in the throwing shoulder by rotating the forearms down towards the ground. This stretch is held for 3 seconds and is repeated twice with approximately 1 to 2 seconds of rest between stretches.  Be sure to stay tall during the stretch and avoid holding your breath.
  2. Elbow extension stretch. Extend the throwing elbow with the forearm tuned up. With the opposite hand, pull the throwing hand so that the wrist is extended back. This stretch is held for 3 seconds and is repeated twice with approximately 1 to 2 seconds of rest between stretches.  Be sure to stay tall during the stretch and avoid holding your breath.
  3. Big arm circles. Perform big arm circles clockwise and counterclockwise for 5 repetitions each way.  Make the circles as big and fast but comfortable, with an emphasis on increasing range of motion.  Be sure to stay tall during the exercise.
  4. Small arm circles. Perform small, tight arm circles clockwise and counterclockwise. Movement is fast but at a comfortable pace.  Perform 5 circles forward, and 5 circles in reverse.
  5. Forearm touch. With the arms up out to the side and elbows bent, move the elbows in so the elbows and forearms touch.  Next, move the arms in the opposite direction until a mild stretch is felt in the front of the shoulders or chest.  Repeat 5 times continuously.
  6. 90/90 IR and ER. Begin with the arms up out to the side and elbows bent. Internally and externally rotate the shoulders as far as possible at a fast but comfortable pace. Repeat 5 times continuously.  Be sure to stay tall and breathe during the exercise.
  7. Trunk Rotation. Begin with the arms fully extended and out to the side.  Rotate your arms and trunk from side to side, through a full range of motion, to the left and then back to the right. Movement is fast but at a comfortable pace.  Repeat 5 times continuously.

Closing Thoughts

Performing the two-out drill with two outs will allow adequate time to prepare the throwing shoulder for the subsequent inning.  This may be a practical and effective means to preserve shoulder range of motion throughout the course of a baseball game.  Rest and avoiding excessive throwing is undoubtedly the most important factor related to reducing risk for arm injuries in baseball players.  However, the two-out drill may help maintain shoulder flexibility during a game, and perhaps over the course of a season.  Maintaining shoulder range of motion is just one small piece to minimizing risk for injury in baseball players.

References

  1. Escamilla RF, Yamashiro K, Mikla T, Collins J, Lieppman K, Andrews JR. Effects of a short-duration stretching drill after pitching on elbow and shoulder range of motion in professional baseball pitchers. Am J Sports Med. 2016;45(3):692-700. doi:10.1177/0363546516671943.
  2. Reinold MM, Wilk KE, Macrina LC, et al. Changes in shoulder and elbow passive range of motion after pitching in professional baseball players. Am J Sports Med. 2008;36(3):523-527. doi:10.1177/0363546507308935.
  3. Wilk KE, Macrina LC, Fleisig GS, et al. Correlation of glenohumeral internal rotation deficit and total rotational motion to shoulder injuries in professional baseball pitchers. Am J Sports Med. 2011;39(2):329-335. doi:10.1177/0363546510384223.
  4. Wilk KE, Macrina LC, Fleisig GS, et al. Deficits in glenohumeral passive range of motion increase risk of elbow injury in professional baseball pitchers: A prospective study. Am J Sports Med. 2014;42(9):2075-2081. doi:10.1177/0363546514538

 

 

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. https://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. https://doi.org/10.1136/bjsports-2013-092952

Early Sports Specialization in Young Athletes

In the United States, it is estimated that 72% of school-aged youth (8 to 17 years old) participate in at least one organized sport. Sports participation has many benefits, including living a healthy lifestyle, having a positive self-image, and building social relationships. It is also estimated that nearly 30% of school-aged athletes specialize in a single sport year-round6.  Early sports specialization has been defined as intensive year-round training in a single sport at the exclusion of other sports4. This may include athletes who:

  1. Choose one main sport,
  2. Participate for greater than eight months per year in one main sport, and
  3. Quit all other sports to focus on one sport.

Young athletes who engage in year-round intense training programs in a single sport are prone to overuse injuries, burnout, and dropping out of sports. Sports believed to be most susceptible to these negative consequences are baseball (pitchers especially), cheerleading, gymnastics, soccer, swimming, tennis, and volleyball.

Injury, Burnout, and Dropping out of Sports

Evidence is emerging which shows specialized young athletes are at more risk for injury compared to those who engage in multiple sports. One study of 7 to 18 year old athletes, showed that those who specialized in a single sport were 2.25 more likely to sustain a serious overuse injury compared to unspecialized young athletes4. Another study of 546 high school athletes found a relationship between the development of knee injuries and single- sport training in those engaged in basketball, soccer, and volleyball3. It appears that female high school athletes who specialize in a single sport are particularly vulnerable to hip and knee overuse injuries1,3. A possible explanation for these injury trends is the lack of diversified activity which may not allow young athletes to develop the appropriate neuromuscular skills that are effective in injury prevention. Year-round training in a single sport also does not allow for the necessary rest from repetitive use of the same muscles and segments of the body. The positive transfer of skill with diversification of sport participation is important in the successful development of any young athlete2.

Young athletes are under a tremendous amount of pressure brought about by adult-driven specialized training programs, weekend tournaments, showcases, and competitions. The psychological risk of burnout, depression, and increased risk of injury is believed to result in withdrawal from sport. In the physical therapy clinic, we are faced with many young athletes who lose their desire to return to sport following injury. It is my belief that these young athletes view their injury as a means to escape from the increased pressures of youth sports.

Research has indicated that adolescents need to enjoy their sport, and that intrinsic motivators are keys to maintaining participation and goal achievement in sports. Unfortunately, this is often not the case as the temptation of collegiate scholarships and stardom causes thousands of adolescent athletes to specialize in single sports. While this may result in more highly skilled, sport-mature athletes at a younger age, it is isolating the child and has the potential to lead to increased stress and pressure. Consequently the child loses a sense of control or decision-making power over their lives. These consequences may be far-reaching with the adolescents overall maturation and development5.

Conclusion

Parents and coaches should be cautious with encouraging young athletes to engage in intense year-round training specialized in any single sport. Adults involved in instruction of youth sports should be on the alert for signs of burnout, and physical symptoms in highly specialized athletes and be prepared to take corrective action such as backing off training. A more proactive approach is the better option. Encouraging multiple sports participation has the benefits of reducing injury risk, decreasing the chance of burnout, and the promotion of basic motor skills which will enhance the young athletes overall development throughout their lifespan.

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. Fransen J, Pion J, Vandendriessche J, et al. Differences in physical fitness and gross motor coordination in boys aged 6 – 12 years specializing in one versus sampling more than one sport. J Sports Sci. 2012;30(4):379-386.
  3. Hall R, Foss KB, Hewett TE, Myer GD. Sport specialization’s association with an increased risk of developing anterior knee pain in adolescent female athletes. J Sport Rehabil. 2015;24:31-35.
  4. Jayanthi NA, Labella CR, Fischer D, Pasulka J, Dugas LR. Sports-specialized intensive training and the risk of injury in young athletes: A clinical case-control study. Am J Sports Med. 2015;43(4):794-801. doi:10.1177/0363546514567298.
  5. Myer GD, Jayanthi N, Difiori J p, et al. Sport specialization, part I: Does early sports specialization increase negative outcomes and reduce the opportunity for success in young athletes? Sport Heal A Multidiscip Approach. 2015;7(5):437-442. doi:10.1177/1941738115598747.
  6. Myer GD, Jayanthi N, Difiori JP, et al. Sports specialization, part II: Alternative solutions to early sport specialization in youth athletes. Sport Heal A Multidiscip Approach. 2016;8(1):65-73. doi:10.1177/1941738115614811.
  7. 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.