Hockey Injuries Hockey Injuries

Presented to USA Hockey Presented to USA Hockey CoachesCoaches

byby

Dr. Susan B. Hoppe, Ed.D, Dr. Susan B. Hoppe, Ed.D, ATCATC

3 key injuries & topics to 3 key injuries & topics to knowknow

1.1. Neck injuriesNeck injuries

2.2. Concussions/Head injuriesConcussions/Head injuries

3.3. Prevention and Training Techniques Prevention and Training Techniques including nutrition tipsincluding nutrition tips

Spine AnatomySpine Anatomy

Different curves in Different curves in the spine built for the spine built for shock absorptionshock absorption

More likely to have More likely to have cervical spine cervical spine fracturesfractures

More likely to More likely to herniate discs in herniate discs in lumbar spinelumbar spine

Functional AnatomyFunctional Anatomy

Movements of the spine include flexion, Movements of the spine include flexion, extension, right and left lateral flexion and extension, right and left lateral flexion and right and left lateral rotationright and left lateral rotation Minimal movement w/in the thoracic regionMinimal movement w/in the thoracic region

Superficial and deep musculature Superficial and deep musculature functioning and abdominal muscular functioning and abdominal muscular functioning affect movementfunctioning affect movement Flexion and extensionFlexion and extension Trunk rotation and lateral flexionTrunk rotation and lateral flexion

Cervical Spine ConditionsCervical Spine Conditions Mechanisms of Injury Mechanisms of Injury

Neck InjuriesNeck Injuries If an athlete tells you that:If an athlete tells you that:

They can’t move their fingers or toesThey can’t move their fingers or toes Something “feels different” in my Something “feels different” in my

fingers or toesfingers or toes They have a burning, tingling or numb They have a burning, tingling or numb

sensations in any of their extremitiessensations in any of their extremities They have any pain along their spine…They have any pain along their spine…

What should you do?What should you do?

DO NOT MOVE THEM!DO NOT MOVE THEM!

Neck injury managementNeck injury management

At a gameAt a game:: Tell your athlete not to moveTell your athlete not to move Ask them where their pain is locatedAsk them where their pain is located Ask the EMT’s for assistanceAsk the EMT’s for assistance

At practiceAt practice:: Do not allow the athlete to moveDo not allow the athlete to move Ask them where the pain is locatedAsk them where the pain is located Call 9-1-1 if there is any question that Call 9-1-1 if there is any question that

there is a fracture presentthere is a fracture present

Concussions & Head injuriesConcussions & Head injuries

Concussion Concussion

An impairment of normal An impairment of normal neurological function due to a neurological function due to a blow to the head or abrupt blow to the head or abrupt movement of the headmovement of the head

““Mild” concussionMild” concussion

Minimal intensityMinimal intensity Dazed and disorientedDazed and disoriented No amnesia or any other signs of No amnesia or any other signs of

serious head injuryserious head injury Back to normal in 5’ – 15’Back to normal in 5’ – 15’

No further play that dayNo further play that day

““Moderate” ConcussionModerate” Concussion

Mild intensityMild intensity No loss of No loss of

consciousness (LOC)consciousness (LOC) Slight temporary Slight temporary

anterograde amnesia anterograde amnesia (can’t make new (can’t make new memories)memories)

Minor mental Minor mental confusionconfusion

TinnitusTinnitus Dull headacheDull headache

UnsteadyUnsteady Minor dizzinessMinor dizziness Post-concussion Post-concussion

problemsproblems HeadachesHeadaches IrritabilityIrritability

No further play No further play that daythat day

““Severe” ConcussionSevere” Concussion

S & S of “mild” and S & S of “mild” and “moderate” “moderate” concussionsconcussions

Loss of Loss of consciousnessconsciousness

Moderate tinnitusModerate tinnitus Retrograde amnesia Retrograde amnesia

(before injury) and (before injury) and or anterograde or anterograde amnesia (after amnesia (after injury)injury)

Mental confusionMental confusion

Balance problemsBalance problems AutomatismAutomatism

No return to play No return to play that daythat day

What do you need to know?What do you need to know?

If there are If there are anyany residual symptoms, residual symptoms, athlete cannot playathlete cannot play

Every concussion is different…Every concussion is different…symptoms may last 5 minutes or 5 symptoms may last 5 minutes or 5 monthsmonths

Never give them aspirin or IbuprofenNever give them aspirin or Ibuprofen The second hit is when more damage The second hit is when more damage

can be done!can be done!

Postconcussion SyndromePostconcussion Syndrome EtiologyEtiology

Condition which occurs following a concussionCondition which occurs following a concussion May be associated with head injuries that May be associated with head injuries that

don’t involve a LOC or in cases of severe don’t involve a LOC or in cases of severe concussionsconcussions

Signs and SymptomsSigns and Symptoms Athlete complains of a range of Athlete complains of a range of

postconcussion problemspostconcussion problems Persistent headaches, impaired memory, lack of Persistent headaches, impaired memory, lack of

concentration, anxiety and irritability, giddiness, concentration, anxiety and irritability, giddiness, fatigue, depression, visual disturbancesfatigue, depression, visual disturbances

May begin immediately following injury and May begin immediately following injury and may last for weeks to monthsmay last for weeks to months

Postconcussion SyndromePostconcussion Syndromecontinuedcontinued

ManagementManagement Health care team should treat Health care team should treat

symptoms to greatest extent possiblesymptoms to greatest extent possible Return athlete to play when all signs Return athlete to play when all signs

and symptoms have fully resolved (upon and symptoms have fully resolved (upon physician’s direction)physician’s direction)

Second Impact SyndromeSecond Impact Syndrome

EtiologyEtiology Result of rapid swelling and herniation of Result of rapid swelling and herniation of

brain after a second head injury before brain after a second head injury before symptoms of the initial injury have symptoms of the initial injury have resolvedresolved

Second impact may be relatively minimal Second impact may be relatively minimal and not involve contact w/ the craniumand not involve contact w/ the cranium

Impact disrupts the brain’s blood Impact disrupts the brain’s blood autoregulatory system leading to autoregulatory system leading to swelling, increasing intracranial pressureswelling, increasing intracranial pressure

Second Impact SyndromeSecond Impact Syndrome

Signs and SymptomsSigns and Symptoms Often athlete does not have a LOC and Often athlete does not have a LOC and

may looked stunnedmay looked stunned W/in 15 seconds to several minutes of W/in 15 seconds to several minutes of

injury athlete’s condition degrades injury athlete’s condition degrades rapidlyrapidly

Dilated pupils, loss of eye movement, LOC Dilated pupils, loss of eye movement, LOC leading to coma, and respiratory failureleading to coma, and respiratory failure

Second Impact Syndrome Second Impact Syndrome (continued)(continued)

ManagementManagement Life-threatening injury that must be Life-threatening injury that must be

addressed within 5 minutes with life saving addressed within 5 minutes with life saving measures performed at an emergency measures performed at an emergency facilityfacility

Best management is prevention from the Best management is prevention from the AT’s perspectiveAT’s perspective

Prevention of Head injuriesPrevention of Head injuries

Protective equipmentProtective equipment HeadgearHeadgear Helmets and facemaskHelmets and facemask Mouthpieces (teeth)Mouthpieces (teeth)

Proper techniques in initiating Proper techniques in initiating contactcontact

Education about concussions and Education about concussions and second impact syndromesecond impact syndrome

Prevention of other injuriesPrevention of other injuries

Dynamic warm upDynamic warm up FlexibilityFlexibility Core stabilityCore stability Equipment needsEquipment needs Proper care of small injuries before Proper care of small injuries before

they become big problemsthey become big problems Nutritional needsNutritional needs

Dynamic warm-upDynamic warm-up

Major muscle Major muscle groupsgroups

Move laterally as Move laterally as wellwell

Controlled Controlled movementsmovements

Progress to quicker Progress to quicker and higher and higher intensity activitiesintensity activities

Should be sweating Should be sweating BEFORE on the iceBEFORE on the ice

FlexibilityFlexibility

Static stretchingStatic stretching Throughout day, Throughout day,

not just 10 minutes not just 10 minutes on ice before & on ice before & after practiceafter practice

Only need to hold Only need to hold 15 seconds x 3 15 seconds x 3 setssets

Hip mobility is keyHip mobility is key

Core strength: Abdominal Core strength: Abdominal MusclesMuscles

Core: not Core: not justjust Abs! Abs!

ExercisesExercises

Let’s try a couple…Let’s try a couple…

Nutrition: Keys to SuccessNutrition: Keys to Success

BreakfastBreakfast Eating balanced mealsEating balanced meals Healthy SnackingHealthy Snacking Recovery nutritionRecovery nutrition HydrationHydration

BreakfastBreakfast

Improves concentrationImproves concentration Enhances focusEnhances focus Jump-starts the Jump-starts the

metabolismmetabolism Helps muscles Helps muscles

maximize strengthmaximize strength Boosts enduranceBoosts endurance Supports weight controlSupports weight control Contributes to Contributes to

increased academicsincreased academics

½ Fruits and ½ Fruits and VegetablesVegetables

¼ Protein¼ Protein

¼ Whole ¼ Whole GrainsGrains

Small Small Amount of Amount of FatsFats

HydrationHydration

¼ Fruits and ¼ Fruits and VegetablesVegetables

¼ Protein¼ Protein

½ Grains½ Grains

Small Small Amount of Amount of FatsFats

HydrationHydration

Healthy SnackingHealthy Snacking

Choose nutrient-rich foodsChoose nutrient-rich foods Don’t go more than 4 hours without eatingDon’t go more than 4 hours without eating Choose items high in fiber and Choose items high in fiber and

antioxidants to keep your system antioxidants to keep your system functioning at its peakfunctioning at its peak

Recovery Nutrition: 3 R’sRecovery Nutrition: 3 R’s RefuelRefuel: Eat simple carbs to : Eat simple carbs to

replace those used during replace those used during activityactivity

RebuildRebuild: Eat protein to : Eat protein to promote muscle repair & promote muscle repair & maximize muscle strengthmaximize muscle strength

RehydrateRehydrate: Drink water, : Drink water, sports drinks, flavored milk to sports drinks, flavored milk to replenish fluids & electrolytes replenish fluids & electrolytes lost in sweatlost in sweat

HydrationHydration Important for achieving peak performanceImportant for achieving peak performance Helps prevent heat illnessHelps prevent heat illness Early signs of dehydration:Early signs of dehydration:

ThirstThirst Flushed skinFlushed skin Increased body temperatureIncreased body temperature Faster breathing and pulse rateFaster breathing and pulse rate Increased perception of effortIncreased perception of effort Decreased exercise capacityDecreased exercise capacity

Hydration tipsHydration tips Drink every 15 minutes during Drink every 15 minutes during

exerciseexercise Drink 3 cups of fluid for every pound Drink 3 cups of fluid for every pound

lost during physical activitylost during physical activity Individuals check urine for colorIndividuals check urine for color

If ever in doubt about your If ever in doubt about your athlete’s health…athlete’s health…

Ask a health care provider!Ask a health care provider!

Any questions?Any questions?

Dr. Susan Hoppe, EdD, ATCDr. Susan Hoppe, EdD, ATC

sbritton@d.umn.edusbritton@d.umn.edu