Injuries in Ice Hockey

Transcription

1 Adriano Vretaros Strength and Conditioning Coach São Paulo BRAZIL

2 Types Accidents Musculoskeletal Injuries Pathologies of the Airways

3 Researches Definition of Injury Epidemiology Investigated Period General Injuries and \ or Specific Injury In the Game, Practice and \ or Training Tactical Role

4 Definition of Injury - I Harmony between DIFFERENT DEFINITIONS Sport Formation vs. Competitive Sport a) Ability Body Tolerate Loads b) Behavioral Factors, Physiological and Biomechanical Adaptations c) Uniformity Plans (Prevention, Treatment and Rehabilitation) d) Structural and Functional Integrity (Atalaia, Pedro & Santos, 2009)

5 Definition of Injury - II Acute or Chronic Contact or No Contact Extrinsic or Intrinsic Factors

6 Epidemiology Incidence Prevalence

7 Investigated Period Day (s) Week (s) Month (s) Season (s) Pre-season (s) Off-season (s)

8 General Injuries and \ or Specific Injury General or Local If Location: a) Head b) Trunk c) Upper Limb d) Lower Limb

9 Tactical Role Case Study Function (s): Forwards Defensemen Goaltender

10 Motor Actions in Ice Hockey - I CHARACTERISTICS: a) Start and Stop b) One-on-one c) Intermittent Collision Sport (nature) d) Explosive Dynamic Movements Patterns GAME TASKS: 1) Closed Kinetic Chain Movements 2) Absolute Strength 3) Muscular Power 4) Endurance (MacLean, no date)

11 Motor Actions in Ice Hockey - II Rotational Movements: a) Hip b) Trunk c) Shoulders Slap Shot (Force Generated): 1) 25% Trunk 2) 40-45% Shoulders 3) 30-35% Elbow and Wrist (Raether, 2014)

12 Motor Actions in Ice Hockey - III Externally and Internally Rotate the Hip Strong Connection: LPH, Trunk and Shoulder Skating (acceleration, deceleration, checking) Stick Skills (passing, shooting, checking) (Roether, 2014)

13 Motor Actions in Ice Hockey - IV SKATING TECHNIQUES PRINCIPLES: a) Force Generation b) Circle Physics c) Center of Gravity d) Acceleration e) Momentum f) Inertia (Stamm, 2010)

14 Real Problems - I Complex Motor Skills at a High Rate of Speed Absorb Physical Contact from Opposing Players React to a Constantly Changing Enviroment To Balance on One-eighth Inch Wide Blades of Steel Strength to Maintain Balance Violent Game Played at High Velocities Very Unforgiving Surface (Rolinski, 2013)

15 Real Problems - II Ice Skating: Trunk Flexion Forward Isometric Contraction of the Extensors Back Actions Stressful Torsions Unequal Distribution: Absorb Forces of Compression and Shear Strength Forces Impacts (contacts) (MacLean, no date)

16 Real Problems - III Game Equipment (STICKS and PUCKS) Protective Equipment (HELMET)

17 MUSCLES IN HOCKEY SKATING

18 EQUIPMENT

19 Accidents Concussions Collision with Opponents Collision with Boards Sticks Pucks

20 PHYSICAL CONTACT E

21 Physical Contact - I TYPES OF BODY CONTACT Trunk, Limb or Object Pushing Holding Slashing Tripping (Goulet et al, 2016)

22 Physical Contact - II CHARACTERISTICS MEASUREMENTS Type of Physical Contact Made with TRUNK (Intensity: 1 to 5) Other Types: Slashing, Holding, Pushing, Tripping WHO provide the Physical Contact DEFENSIVE PLAYER OFFENSIVE PLAYER PUCK CARRIER NON PUCK CARRIER INTENSION of the player when doing the Physical Contact DELIBERATE NON DELIBERATE (Adapted from Goulet et al, 2016)

23 Physical Contact - III ONE SEASON: January-March 2009 (YOUTH Ice Hockey) BODY CHEKING: 45 to 86% (Mechanism of Injury) Sustainability of the Player TRUNK: 5610 physical contact (90,9\team-game) Other Types: 3429 physical contact (55,3\team-game) BODY CONTACT # BODY CHECKING (Goulet et al, 2016)

24 CONCUSSIONS CLICK in VIDEO - Linesman Concussion (LaVoi, 2010 ; Greenwell, 2013)

25 Concussions - I CONCUSSION: Transmission of Force to the Brain Direct and\or Indirect Impact: Head, Face, Neck or elsewhere along the body HELMETS vs. Concussions=??? PROTECTION: Linear Focal Point IMPACTS: Rotational Acceleration and Linear Forces (Izraelski, 2014 ; LaVoi, 2010)

26 Concussions - II 08 teams DIVISION I 1 Season (men's collegiate) TOTAL: 113 injuries athlete-exposure 65% in Games Overall Injuries: 4,9 per 1000 athlete-exposure 13,8 per 1000 game athlete exposures and 2,2 per 1000 practice athlete exposure Collision with Opponent (32,8%) or Boards (18,6%) (Flik et al, 2005)

27 Concussions - III 3-5 year period ( ) - NHL Season Heads Up Checklist 197 medically diagnosed 88% involved Contact with Opponent FORWARDS (more concussions) 95%CI, 60%, p=0,04 First Period (47%) - p=0,047 (second and third) Defensive Zone (45%) 47% in Open Ice and 53% Perimeter 37% players injuries Contact with Boards or Glass (Hutchison et al, 2015)

28 Concussions - IV Diagnosis Management Return-to-play Protocols (Izraelaski, 2014)

29 TYPES OF HELMETS R

30 Eye Injuries - I STICKS - most common cause Average Injured Eyes 13,7 15,0% Blinded PUCKS - high velocities (> 160 km\h) Visual Acuity Before and After Injury Effects on Central and Peripheral Vision HELMETS: With Display and Without Display Players and Goaltenders (Adapted from Pashby et al, 1975)

31 Eye Injuries - II Ocular Blunt Trauma 17 year old male Collision with Opponent STICK travelled under his Half-face Visor Hyphema, Angle Recession, lens Subluxation and Choroidal Rupture over the Macula Reducing his Vision - Permanently Safety Equipment Full-face Protection (Morris, 2009)

32 FACIAL INJURIES t

33 Facial Injuries - I Full Facial Protector (FFP) vs. Half Facial Protector (HFP) Facial Injuries and Lacerations FFP (p<0,05) FFP Relative Risk (RR): 2,31, CI: 1,53 to 3,48 FFP - Return to Training and Games vs. HFP: 1,7 sessions, CI: 1,32 to 2,18 (Asplund et al, 2009)

34 Facial Injuries - II Longitudinal Study: 4 years NCAA Division I TOTAL: 798,5 hours \ practice (163 games) 16 Facial Lacerations 14,9 per 1000 players\game\hours Head and Neck (6,3%) (LaPrade et al, 1995)

35 ACROMIOCLAVICULAR Joint Sprains (McKenney, 2016)

36 Acromioclavicular Joint Sprains NCAA Period: and NCAA SPORTS TOTAL: 844 AC Joint Sprains (1,72 per athlete-exposures CAEs) Sex-comparable Sports In men was 4,67 times that of women (95% CI, 3,56-6,14) SPORTS (soccer, basketball, ice hockey, lacrosse, baseball\softball, swimming and diving) Player Contact (54,7%) and Surface Contact (29,0%) HIGH RATE: soccer, ice hockey and wrestling (Hibberd et al, 2016)

37 SPINAL INJURIES (LaPrade et al, 2000 ; Elsig, 2006 ; Boyd, 2015)

38 Spinal Injuries - I Canada and USA- Period: TOTAL: 42 injuries 34 in Games and 01 in Training TYPES OF VERTEBRAL INJURIES NUMBER OF INJURIES FRACTURE DISLOCATION (burst fractures) 27 FRACTURE 09 DISLOCATION 02 NONE 04 (Adapted from Tator & Edmonds, 1984)

39 Spinal Injuries - II SPINE NEUROLOGICAL INJURIES NUMBER OF PLAYERS Incomplete Spinal Cord Injury 16 Complete Motor Loss, Incomplete Sensory Loss Incomplete Motor Loss, Incomplete Sensory Loss Incomplete Sensory Loss 05 Complete Spinal Cord Injury 12 Nerve Root Injury 05 None (Adapted from Tator & Edmonds, 1984)

40 Spinal Injuries - III Risk of Impacts Player-boards Collisions Player-player Collisions Player with the NECK FLEXED (Time of Collision) Types of Collision: TACKLING and BLOCKING ~ 4 case of quadriplegia per year in Canadian hockey Helmet Neck-muscle-conditioning (Adapted from Tator & Edmonds, 1984)

41 GOALTENDERS INJURIES WikiHow - CLICK in WEBSITE CLICK in WEBSITE

42 Goaltenders Injuries FEMOROACETABULAR IMPINGEMENT (FAI) Phenomenon Prevalent Unique Mechanical Positions Butterfly Technique *** Surgery: Treat SYMPTOMATIC FAI NHL ( ): Hip and Groin Injuries Rates (1,84 per 1000 appearances) Intra-articular HIP Injuries Acetabular Labral (MacIntyre et al, 2015)

43 Musculoskeletal Injuries - I Soft Tissue Strains of the Hip Adductor Tears in the Medial Collateral Knee Ligament ACL strain or minor tear Contusions of the Thigh Inadequate Levels of Strength and Flexibility (adductors and abductors of the legs) Muscle Imbalance: Hamstring \ Quadriceps Overuse Injuries (LaPrade et al, 1994 ; Noyes et al, 1989 ; MacLean, no date)

44 Musculoskeletal Injuries - II SKATING # RUNNING Technique Wind-up Phase Push-off Foot LEG: Externally Rotated to Around 60 ACCELERATION: Posterolateral Plane Cross-over Step (Adductors) Adductor:Abductor ratio <1:1,25 (Nightingale, 2013)

45 Musculoskeletal Injuries - III ADDUCTOR MUSCLE STRAINS: LEVEL CHARACTERISTICS First-degree PAIN - minimal loss of strength and minimal restriction of motion Second-degree TISSUE DAMAGE - compromised the strength of the muscle, but did not include complete loss of strength and function Third-degree COMPLETE DISRUPTION of the muscletendon unit, including complete loss of function of the muscle (Adapted from Tyler et al, 2002)

46 General Injuries - I 8-year study Women's Location Injury Rate (IR) LOWER BODY 2,7\1000 player-games UPPER BODY 1,4\1000 player-games HEAD and FACE 1,3\1000 player-games SPINE and TRUNK 0,9\1000 player-games (Adapted from Tuominen et al, 2015)

47 General Injuries - II Period: : U18 and U20 World Championship- Male Location Injury Rate (IR) LOWER BODY 2,6\1000 player-games UPPER BODY 3,2\1000 player-games SPINE and TRUNK 1,0\1000 player-games LACERATION FACIAL 3,6\1000 player-games BOARD CONTACT 59% of Shoulder Injuries (Adapted from Tuominen et al, 2016)

48 PATHOLOGIES of the AIRWAYS (Denisikhina, Kolosnicin & Lukanina, 2013)

49 PATHOLOGIES of the AIRWAYS Y

50 PATHOLOGIES of the AIRWAYS (Denisikhina, Kolosnicin & Lukanina, 2013)

51 Pathologies of the Airways - I ICE RINK: a) Thermal Conditions b) Indoor Air Quality c) Thermal Confort d) Airflow Patterns e) Ventilation Performance Measured Operating Conditionings: In Game, Training Session, and Maintenance Situation Air Speed, Temperature and Humity Sensors (Lestinen et al, 2016)

52 Pathologies of the Airways - II Temperature rise: 2 C during the game Air Speed: 0,25 0,3 m\s Relative Humity: 30-45% Carbon Dioxide: ppm (during the game) Air Movement: a) Supply Air Temperature b) Variable Air Flow Rates c) Retractable Stands d) Case-dependent (Lestinen et al, 2016)

53 Pathologies of the Airways - III Exercise - INCREASE VENTILATION: >200l\min Exposure to COLD AIR + HYPERVENTILATION Ice Resurfacing Machines in Indoor Ice Arenas: a) Carbon Oxide b) Nitrogen Oxide HIGH OCCURRENCE: a) Asthma b) Bronchial Hyperresponsiveness (Langdeu et al, 2000 ; Helenius et al, 2004)

54 Pathologies of the Airways - IV ICE RINK: Cold Air (5-10 C) Air Quality Problems Cold Air Exposure: Granulocytes and Macrophages Increased: CO, NO and NO2 concentrations a) Asthma Occurrence b) Bronchial Hyperresponsiveness c) Exercise-induced Bronchospasm (Lumme et al, 2003)

55 Pathologies of the Airways - V Abnormalities of Airway Function Cysteinyl Leukotrienes: a) Mucus Production b) Vascular Permeability c) Smooth Muscle Contraction d) Recruitment of Inflammatory Cells (Helenius et al, 2004)

56 Pathologies of the Airways - VI p Ice Hockey Players CONTROL n ATOPY 52 (58) 17 (36) 0,025 Increased bronchial responsiveness 21 (24) 05 (11) 0,097 Current Asthma 13 (15) 01 (02) 0,033 Total Asthma 19 (22) 02 (04) 0,011 (Adapted from Lummen et al, 2003)

57 Severity of the Injury - I Slight Injury (1 to 3 days of absence) Mild Injury (3 to 7 days of absence) Moderate Injury (8 to 28 days of absence) Serious Injury (above 28 days of absence) (Checchi, 2013)

58 Severity of the Injury - II DURATION of ABSENCE PERIOD: a) Trauma Severity b) Nature of Injured Tissue c) Intensity Cure d) Age of the Athlete e) Treatment and Rehabilitation Particularities f) Character the Training Activity (Platonov, 2008)

59 Injury Prevention - I EPIDEMIOLOGISTS & STATISTICIANS (Parkkari, Kujala & Kannus, 2001)

60 Injury Prevention - II Identify the Incidence Identify Risk Factors Interventions to Address the Risk Factors Test the Effectiveness of the Intervention (Tyler et al, 2002)

61 Injury Prevention - III Injury Problems (number, incidence, time trends, severity, consequences, impairments, disabilities and costs) Etiology, Risk Factors and Mechanisms of Injuries Preventive Measure or Programme Assessing the Effectiveness and Cost Effectiveness of the Preventive Action (Adapted from Parkkari, Kujala & Kannus, 2001)

62 Injury Prevention - IV Anamnesis Injury History Pre-season Tests

63 Injury Prevention - V Equipments: a) Helmets b) Sticks c) Pucks d) Ice Skates Rules

64 Existence of Injury - I 1) Type of Injury 2) Evaluation 3) Treatment

65 Existence of Injury - II PRICE Protection Rest Ice Compression Elevation

66 Evaluation of Injury Inspection Physical Exam Diagnostic Testing (x-ray, CT scan, MRI and\or NVC\EMG, etc.) (DeFrancesco & Inesta, 2012)

67 Hierarchy of Control Injured Athlete Sports Medicine Physician Examinations, Diagnostic Evaluation, Treatment Indication Sports Physiotherapist Rehabilitation, Functional Reevaluation of the Injured Limb Physical Preparation Coach Muscle-functional Adaptation for Sport, Specific Physical Conditioning (Adapted from Vretaros, 2002)

68 Training and Injury Prevention - I R Mobility Warm up Movement Learning Proprioception Stability CORE Strength Power

69 Training and Injury Prevention - II Prehab Hydration

70 Training and Injury Prevention - III DEVELOP TECHNIQUES TO: 1) FALLS in physical contact with opponents case 2) MUFFLE in physical contact case with boards EXAMPLE: a) Agility Training in Skating Ring

71 Training and Injury Prevention - IV ADDITIONAL THERAPIES: 1) Pilates 2) Yoga 3) Chiropractic 4) Rolfing 5) Global Posture Reeducation 6) And others

72 Effects & Causes Serious Surgery and \or Prolonged Immobilization Risk of Permanent Damage Time Spent and Financial Resources Treatment and\or Rehabilitation Recovery of Systemic Adaptations of Biomotor Capabilities at the Level of Competitive Training