Ice Hockey (Care of the Young Athlete)

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Ice hockey is one of the fastest sports and
requires good physical conditioning and skating skills. It is a team sport
played from the ages of 5 to 6 years through adulthood.

The severity of injuries is related to speed and
physical contact (body checking). In the United States, body checking is allowed
in league hockey at the age of 11 to 12 years, although the age can be younger
in some leagues.

As player size and the speed of the game increase,
injury rates and the severity of injury also rise. However, the risk of injuries
can be reduced.

The following is information from the American
Academy of Pediatrics (AAP) about how to prevent ice hockey injuries. Also
included is an overview of common ice hockey injuries.

Injury prevention and safety tips

  • Equipment. Safety gear
    should fit properly and be well maintained.

    • Skates should fit
      well with socks on. Skates that are too tight can lead to
      blisters and frostbite.

    • Pads. Elbow, knee,
      and shoulder pads that fit properly and allow for full movement.
      Kidney- and thigh-padded shorts that overlap protective socks
      and shin guards so no skin is showing. Padded hockey gloves to
      protect the fingers and wrists from stick slashing and sharp
      skates.

    • Protective guards
      (neck guards, protective cups, and mouth guards)

    • Helmets with face
      guards
      approved by the Hockey Equipment Certification
      Council (HECC). Cracked helmets or helmets with outdated HECC
      certificates should not be used.

    • Goalie equipment is
      even more specialized, with a different helmet and mask, thicker
      padding, and skates with longer, thicker blades for stability
      and reinforcement along the inner foot for protection from pucks
      and sticks.

  • Equipment care. Dirty
    hockey equipment can lead to skin infections, especially where the
    hockey gear touches the skin directly. The “infamous”
    hockey bag smell is due to the growth of bacteria and other germs.
    Almost all equipment can be washed in a commercial washing machine.
    Helmets and face masks can be disinfected with antibacterial wipes, and
    the inside of leather gloves and gear bags can be cleaned with spray
    cleaners. Mouth guards should be washed after each use.

    Many rinks have special
    “dry” cleaning machines that disinfect an entire bag of
    gear. To decrease the growth of germs, gear should be taken out of the
    bag after every practice or game, and the bag and gear dried out
    completely before repacking.

  • Environment. Only walk or
    skate on a pond or natural body of water that has received safe ice
    approval from local officials. Also, goal net posts should be easily
    removed so they are not dangerous obstacles during fast play.

  • Emergency plan. Hockey
    programs can organize and train a team to respond to injuries during
    games, as it is rare to stop play while players are treated off the ice.
    The plan would include first aid and emergency contact information. All
    members of the team should receive a written copy each season. Parents
    also should be familiar with the plan and review it with their
    children.

Special concerns

Dehydration

There is a common misconception that
athletes who play in cold weather do not need to drink as much as those
playing in warm weather. In fact, hockey players training in cold
environments wear more clothing and may be unaware they are losing body
moisture. Dehydrated athletes often perform poorly in multiple game
situations like tournaments and during the last period of a game.

Hydration should take place before, during,
and after games and practices. In general, athletes should drink 5 to 8
ounces of water or an appropriate sports drink every 20 minutes, even if
they do not feel thirsty. Players not responding well, unable to drink, or
with difficulty breathing may need emergency medical attention.

Exercise-induced asthma

  • Exercise-induced asthma is prevalent
    in hockey players who are prone to asthma because hockey is played
    in cold weather under dry conditions. Skaters should have a personal
    asthma action plan. Asthmatic skaters can prevent episodes by taking
    their medicines and using an inhaler before practices or games.
    Inhalers and spacers should always be on hand during activity.
    Skaters should stop skating and see a doctor if they have difficulty
    breathing while skating.

Frostbite

Cold weather, wet clothing, and
tight-fitting skates can lead to poor circulation and frostbite. Early signs
of frostbite are pale or white skin with numbness and tingling of the
exposed body part. It is important to dress in layers and wear wicking,
fast-drying wool or polypropylene underwear and socks. Cotton clothing is
not warm when wet and can contribute to frostbite and hypothermia by
lowering the body temperature. Treat frostbite by increasing circulation and
warming cold body parts in a heated room or under the clothes. Change wet
clothing often.

Common injuries

Head injuries

Concussions in hockey most often occur from
a blow to the head, from falls, or from being checked into the boards. A
concussion is any injury to the brain that disrupts normal brain function on
a temporary or permanent basis.

The signs and symptoms of a concussion range
from subtle to obvious and usually happen right after the injury but may
take hours to days to show up. Athletes who have had concussions may report
feeling normal before their brain has fully recovered. With most
concussions, the player is not knocked out or
unconscious.

Prematurely returning to play after a
concussion can lead to another concussion or even death. An athlete with a
history of concussion may be more susceptible to another injury than an
athlete with no history of concussion.

All concussions are serious, and all athletes with suspected
concussions should not return to play until they see a doctor.

Youth hockey programs in the United States
and Canada have active head injury prevention programs for athletes and
coaches. Safe play and properly fitting helmets can prevent concussions, as
does striking the boards at an angle with the head up when a collision
can’t be avoided.

Arm and leg injuries

Injuries of the extremities should be
treated with rest, ice, compression, and elevation (RICE). Nonsteroidal
anti-inflammatory drugs (NSAIDs) may help reduce pain and swelling, but
should be taken with food. Injured athletes should see their doctor if they
have pain while playing.

  • Upper extremity injuries of
    the shoulder, arm, and wrist
    occur during falls or from
    being checked into the boards. Shoulder dislocations are very
    painful until put back into place. Persistent wrist or arm pain
    after a fall can signify a broken bone (even if there is no visible
    swelling or deformity) and should be iced and immobilized until it
    can be treated by a doctor.

  • Groin strains are
    pulled or torn muscles or tendons of the inner thigh. Hockey players
    and goalies doing forced push offs or slides on skates may get this
    injury. Treatments that may help are ice, NSAIDs, thigh wraps,
    physical therapy, and modification of activity. Groin strains can be
    prevented by warming up properly and doing muscle stretching as a
    part of team practices and games.

  • Knee injuries are more
    common in hockey than ankle injuries because the ankle and Achilles
    tendon are protected by a stiff boot. Knee injuries happen when the
    knee is forced or twisted to the side or back. If a ligament or
    cartilage is torn, a pop may be felt or heard, followed by visible
    swelling around the knee.

  • Overuse injuries, such
    as Osgood-Schlatter disease (irritation of the growth plate causing
    a painful bony bump below the knee), occur in 10- to 15-year-olds
    who play active sports with running, jumping, or skating. In hockey,
    a combination of off-ice training, overtraining, and frequent
    practices and games may lead to Osgood-Schlatter, thus limiting or
    changing activity may help.

Eye injuries

In the past, blows from hockey sticks and
flying pucks caused many eye injuries. Now helmets with face masks have
decreased the number of eye injuries, but they still can occur. Any injury
that affects vision or is associated with swelling or blood inside the eye
should be evaluated by an ophthalmologist. The AAP recommends that children
involved in organized sports wear appropriate protective eyewear.

Remember

Ice hockey injuries can be prevented by treating
injuries appropriately, wearing protective equipment including helmet and face
guards, following the rules of the game, and practicing good sportsmanship.