Common Hockey Injuries
How to Reduce Your Risk and Stay on the Ice
Robert Inesta
9/17/20268 min read
Hockey is fast, physical, and demanding. Players accelerate, decelerate, change direction, rotate, shoot, absorb contact, and maintain balance on a very small surface while moving at high speeds on ice.
Since it is a contact sport, not every hockey injury is preventable.
If a player is checked into the boards with enough force, tissue damage can occur regardless of how strong, mobile, or well-conditioned they are. The amount and direction of force will ultimately play a major role in determining whether an injury occurs and how significant that injury may be.
But that doesn't mean hockey players are powerless over injury. Some injuries can be prevented, and the risk or severity of others may potentially be reduced.
While some hockey injuries are primarily traumatic, others develop from repetitive strain and overload. Many involve a combination of both. Understanding that difference helps us focus on an important question:
What can we control?
The goal is to improve the body's ability to tolerate the physical demands of the sport.
Impact Injuries vs. Repetitive Strain Injuries
I generally think about sports injuries in two broad categories.
Impact or traumatic injuries occur from events such as collisions, checks, falls, or awkward contact with another player or the boards.
Repetitive strain or overload injuries develop when tissues are repeatedly stressed beyond their ability to adequately recover and adapt.
There is obviously overlap between the two.
An athlete with poor hip mobility, for example, may develop low back pain or knee issues due to compensating patterns. A player with inadequate shoulder stability may tolerate contact differently than an athlete with a strong and stable shoulder girdle.
In a collision sport, sufficient force can overwhelm even a very well-prepared athlete. But strength, stability, mobility, coordination, and conditioning can help create a more resilient system.
Repetitive strain injuries potentially give us even more opportunity for prevention because many of their contributing factors can be identified and addressed before significant symptoms develop.
It's impossible to make an athlete "injury-proof." The real goal is to do what we can to stack the odds in their favor.
Common Hockey Injuries
Concussions are a common injury and important concern in hockey and deserve a discussion of their own.
For this article, I will focus primarily on several mechanical hockey injuries that are especially relevant to my work as a musculoskeletal practitioner:
Shoulder and AC joint injuries
Groin/adductor strains
Knee injuries, especially the MCL
Low back pain
Interestingly, these seemingly different injuries share several underlying physical qualities that can be worked on.
1. Shoulder and AC Joint Injuries
The acromioclavicular, or AC, joint is located at the top of the shoulder where the collarbone meets the front part of the shoulder blade.
According to the National Strength and Conditioning Association, AC joint injuries are among the most common shoulder injuries in hockey players. The organization also points to shoulder instability as an underlying risk factor and emphasizes the importance of the muscles surrounding the shoulder blade, or scapula, in creating dynamic shoulder stability.
Of course, no amount of strengthening can guarantee that an athlete won't injure an AC joint during a hard collision. But improving the muscular support surrounding the shoulder can help create a stronger, more stable system for absorbing and distributing force.
Don't Forget the Shoulder Blade
When people think about shoulder strength, they often think about the deltoids, chest, or rotator cuff. But the shoulder blade, or scapula, is the foundation upon which much of the shoulder functions.
Good scapular control requires coordinated activity from muscles including the trapezius, rhomboids, serratus anterior, and rotator cuff. Exercises such as rows, Y and T variations, carries, controlled pressing, and appropriate rotator cuff strengthening can help build this foundation.
But there is another important component often not associated with the shoulder: the trunk/core.
The shoulder doesn't function independently from the rest of the body. The whole body functions together as a unit.
Research and clinical rehabilitation models increasingly recognize the importance of integrating shoulder function with trunk, or core, stability and the rest of the kinetic chain including the hip and lower extremity.
This is especially important in hockey, where shooting, checking, stick handling, and absorbing contact all involve forces traveling through the entire body.
2. Groin and Adductor Strains
Groin injuries are another common problem among hockey players. This isn't surprising when we consider the mechanics of skating.
The adductor muscles, located on the inner thigh, are repeatedly loaded during skating, particularly as the leg moves away from and back toward the midline of the body.
The NSCA notes that powerful forward and crossover skating requires substantial eccentric strength from the adductors. Eccentric strength refers to muscle contraction as the muscle is lengthening and essential for control. Previous groin injury, insufficient hockey-specific offseason conditioning, and imbalances between the adductor and abductor muscles can all be risk factors.
One particularly interesting finding cited in the NSCA review is that adductor strains have been reported much more frequently during preseason on-ice training and games than during the regular season. This demonstrates the importance of preparation.
Strength Matters, but So Does Mobility
A good prevention program should build strength, improve mobility, and improve coordination throughout the hips rather than simply stretching the groin.
Useful exercises may include adductor strengthening, lateral lunges, squat variations, glute strengthening, single-leg balance/proprioceptive exercises, slide-board work, and exercises that reproduce aspects of the skating motion.
Mobility is important because a hip that cannot move properly may force neighboring areas to compensate. That can contribute not only to hip and groin problems, but potentially to stress at the knee and lower back as well.
This is a major reason I consider hip function such an essential part of athletic, and overall musculoskeletal, health.
3. MCL and Knee Injuries
The medial collateral ligament, or MCL, runs along the inside of the knee and is one of the more commonly injured knee structures in hockey.
Many MCL injuries occur when a force drives the knee inward while the lower leg or skate is relatively fixed.
Once again, we cannot completely protect an athlete from a sufficiently powerful collision. No matter how strong someone may be, this is still a vulnerable area. But we can improve the system surrounding the knee. Protecting the knee isn't only about strengthening the knee itself.
Look Above and Below the Knee
The knee sits between the hip and the ankle. Poor control at either end can affect the forces experienced by the knee.
Hip strength and mobility, gluteal function, single-leg stability, balance, and neuromuscular control are therefore important parts of building a more resilient lower extremity.
Exercises such as squats, lunges, step-ups, single leg exercises, lateral movements, agility drills, and appropriately progressed plyometrics can help develop these qualities. For hockey players in particular, training should eventually include movements that challenge stability and force production in positions relevant to skating.
4. Low Back Pain
Low back pain is another common problem I often see with hockey players because of the posture and physical demands involved in skating.
Players spend significant amounts of time in a flexed athletic posture while simultaneously generating powerful movement through the hips and rotating through the trunk.
If the hips or thoracic spine are restricted, the lumbar spine may be asked to compensate. And if trunk stability is inadequate, the lower back may also be exposed to excessive repetitive motion and load.
This brings us back to one of the most important principles in injury prevention:
The location of pain isn't always the location of the problem.
A hockey player with recurring low back tightness or pain may need work directed at the lower back, but we should also assess hip mobility, thoracic mobility, trunk control, and overall skating mechanics.
Three Foundational Concepts I Would Prioritize for Hockey Players
Although every athlete should be evaluated individually, three areas stand out to me when thinking about hockey injury resilience.
1. Shoulder and Scapular Stability
Develop strength and control throughout the shoulder girdle, particularly around the scapula and rotator cuff.
Integrate that stability with the trunk rather than training the shoulder as an isolated body part.
2. Hip Mobility and Strength
The hips have to generate tremendous amounts of force while repeatedly moving through skating-specific ranges of motion.
Adequate mobility should be accompanied by strength throughout those ranges. This is particularly important for the adductors, abductors, glutes, and rotational muscles of the hip.
3. Neutral Spine and Core Stability
"Core strength" isn't simply about doing abdominal exercises. For athletes, I am often more interested in the ability to maintain an efficient spinal position while forces are acting through the body.
The trunk should be able to resist unwanted extension, flexion, and rotation while also allowing powerful movement when appropriate.
Exercises such as McGill's Big Three (bird dogs, curl-ups, and side planks), planks, dead bugs, carries, chops, and lifts can all be useful when programmed appropriately.
Training Is Only Part of the Equation
Strength and conditioning are essential for athletic preparation and it's highly valuable to work with an experienced strength and conditioning coach who understands the mechanics of hockey.
But sometimes an athlete has a physical restriction that makes optimal movement difficult. Some examples include:
A hip may lack rotation.
Adductors may remain chronically tight or overloaded.
The thoracic spine may lack adequate mobility.
The scapula may not stabilize efficiently.
An old injury may have left behind lingering soft-tissue restrictions or altered neuromuscular and movement patterns.
This is where assessment and hands-on treatment can complement a good training program.
In my practice, I often combine myofascial treatment, chiropractic care, acupuncture or dry needling, and specific corrective exercises depending on what I find during the examination.
Myofascial techniques such as Active Release Techniques, or A.R.T., and Stecco Fascial Manipulation can be used to address restrictions and abnormal tension within muscles and fascia.
Joint manipulation or adjustments can help restore appropriate joint motion when a restriction is present.
Acupuncture and dry needling can be useful adjuncts for addressing musculoskeletal pain, muscle tension, and related neuromuscular dysfunction.
This does not replace the work with a strength professional - it works hand in hand. The goal isn't simply to make something "looser." The larger goal is to help restore more normal movement and function, and then reinforce that change through appropriate movement and strengthening.
Mobility without stability isn't enough. Strength without adequate mobility isn't ideal either. We want both.
What If an Injury Has Already Occurred?
When an injury happens, the first step is determining what was actually injured and how severe it is.
Significant trauma, instability, inability to bear weight, neurological symptoms, suspected fracture or dislocation, or symptoms of concussion require appropriate medical evaluation.
For many musculoskeletal injuries, however, treatment eventually follows a progression:
Reduce irritation → restore movement → restore strength and stability → progressively reload the tissue → return to sport.
One of the mistakes athletes sometimes make is confusing the disappearance of pain with complete recovery.
Pain reduction is important, but returning to hockey also requires the injured area to tolerate the speed, force, repetition, and unpredictability of the sport. This is why rehabilitation should ultimately progress beyond symptom relief.
Don't Wait for an Injury
Perhaps the best time to address an injury is before it becomes one.
Recurring tightness, asymmetrical movement, loss of mobility, weakness, or discomfort that repeatedly appears during or after skating may be an indication that an area is being overloaded or not functioning optimally.
That doesn't mean every ache represents an impending injury. But persistent patterns are worth paying attention to.
For competitive athletes, periodic assessment during the preseason and throughout the season can help identify changes in mobility, strength, and movement before they become more significant problems.
The Bottom Line
There is no way to completely prevent injuries in hockey. It is a high-speed contact sport, and sometimes the forces involved are simply greater than the body's tissues can tolerate.
But that doesn't mean injury is purely a matter of luck. There's a lot we can do to better prepare the body for the demands of skating, shooting, checking, and absorbing contact.
We can improve strength, mobility, shoulder and scapular stability, hip function, core stability, and balance. Proactively identifying and addressing restrictions and subtle imbalances before they become larger problems can also be a useful part of keeping the body functioning well.
We may not be able to control everything that happens on the ice.
But when we focus on what we CAN control, we can improve the athlete's ability to handle what we can't.
That is ultimately what good injury prevention, and good athletic preparation, is about.
Dealing With a Hockey Injury or Recurring Tightness?
If you're dealing with a current sports injury, recurring tightness, restricted mobility, or an issue that keeps returning when you train or play, a comprehensive musculoskeletal assessment can help identify factors that may be contributing.
At Berkshire Functional Chiropractic & Acupuncture, I combine myofascial treatment, chiropractic care, acupuncture/dry needling, and corrective movement strategies based on the individual needs of each athlete.
Learn more about sports injury care or schedule an appointment.
Berkshire Functional Chiropractic & Acupuncture
FREE RESOURCES
info@berkshirefunctional.com
(413) 274-7161
© 2024. All rights reserved.