OMT Ice Hockey Module By Valerie Fouts-Fowler, DO and Elliot Taxman - PowerPoint Presentation

OMT Ice Hockey Module By Valerie Fouts-Fowler, DOand Elliot Taxman American College of Osteopathic Pediatricians

A.T. Still and Ice Hockey? Although Andrew Taylor Still never saw ice hockey as we know it today, he would be able to identify with some of the injuries sustained in ice hockey as they are comparable to injuries Still or other young men may have endured working on farms or hunting in the 1800’s throughout Virginia, Tennessee, Missouri, and Kansas. The long days of swinging sickles or scythes, used to harvest hay and grain or to clear underbrush and branches, plowing by hand, and digging with shovels to turn over the land for planting crops, all can lead to injuries that are remarkably similar to those in ice hockey.

The hard work and constant bent over swinging or digging motion used in farm field work resemble the same body positioning, rotation and energy release as in ice hockey players. The foundation of Still’s studies and philosophy are embedded in anatomy. His mastery in structural relationships of muscles, bones, and organs would allow Still to see how injuries in farming can be similar to those seen in ice hockey as well as how to treat ice hockey injuries using manipulative therapies.

Ice Hockey Risk for InjuryHockey players and goalies can be at risk for injury simply due to the games environment, as the game is played on ice and is enclosed by a boarded perimeter. Body checking is an instrumental part of game strategy and game play. High speed collisions unavoidably occur between bodies, bodies and boards, bodies and goal posts, and bodies and pucks at high speeds. Many of these injuries can be acute, however, some can be severe and dangerous. The hockey season is long and strenuous on the body. Some tournament weekends teams can play up to five games with multiple games in a day. It is also likely to have early morning games and games late into the evening. The body weakens over time and under such demanding circumstances making it more susceptible to injury. Many advances in equipment technology have been made and help to prevent injury. However, unfortunately, due to the nature of the sport there are still injuries.

Common Ice Hockey InjuriesNeck and Spine Shoulders Knee, Hip, Thigh, and GroinForearm, Wrist, and Hand painLower Back

Types of Ice Hockey Injuries Fractures, hands and wristSprains or Strains, medial collateral capsular ligaments of the kneeContusions, upper and lower bodySeparations, AC joint separation Skate bite, friction injury from leather of bootConcussions, mild to severeLacerations, head, scalp and face Gamekeeper’s thumb Tearing of the ulnar collateral ligament

Neck, Head and Spine InjuriesNeck, head and spine injuries although not as common do occur and can be harmful. The impact at high speeds with bodies and boards around the ice surface are attributed to these injuries.

Neck, Head and Spine InjuriesMuscles associated are: Sternohyoid muscle BonesSternocleidomastoid muscle Trapezius Splenius Capitis Splenius Cervicis Scalenus MediusScalenus Posterior Levator Scapulae Multifidi (deep) Middle Semispinalis Capitis (Superficial) Rectus Capitus minor and major Oblliquus Capitis Inferior • Cervical Vertebrae -C3 responsible for diaphragm (Breathing) • Brachial Plexus injury -C5 to T1

Rotation

Sidebending

Flexion and Extension

Cradling and TractionThe physician will place the fingers close to the cervical spine and bring anterior pressure bilaterally with slight traction through the arms of the physician.

Counter-Lateral TractionPlace one hand on the frontal bone, the other hand on the lateral aspect of the cervical spine along the articular facets. While applying pressure on the frontal bone away from you, the other hand stretches the muscles of the neck toward you.

Occipital-Atlantal Cervical High Velocity Low AmplitudeThe patient is supine. Place your hand on the ramus of the mandible with fingers extending downward toward the chin. Apply a sudden increase in the rotation of the neck by pressing downward toward the table on the ramus of the mandible.

3rd to 7th Cervical High Velocity Low Amplitude The patient is supine. Rotate and sidebend the neck. The index finger of your hand is posterolateral to the articular process.The patient’s head may be flexed or extended depending on the cervical curve and then the corrective thrust is made with the index finger in an arc conforming to the plane of the facets.

Shoulder Injury Shoulders are one of the most common injuries in ice hockey. The most common injury is an injury to the Acromioclavicular (AC) joint separation. Shoulder contusions and dislocations are also common.

BonesAssociated with the ShoulderBones Associated:ScapulaClavicle Humerus

Muscles Associated with the Shoulder Muscles associated are: Rhomboid Major and Rhomboid Minor Posterior deltoid, Middle deltoid, Anterior deltoid Coracobrachialis muscle Supraspinatus muscle Pectoralis Upper Trapezius Biceps Brachii muscle and Brachialis muscle Triceps

Ligament Associated:Rotator Cuff Axillary Nerve- can’t abduct -off of Brachial Plexus

The seven-step Spencer shoulder technique:Step 1—extension with elbow flexed; step 2—flexion with elbowextended; step 3—compression circumduction; step 4—circumductionwith traction with elbow extended; step 5a—abductionwith internal rotation with elbow flexed; Step 5b- adduction and external rotation step 6—adduction and internal rotation with upper extremity behind the back ; step 7— stretching tissues and pumping fluids with the arm extended

Forearm, Wrist, and Hand Pain InjuryForearms, wrists, and hands are all at risk for breaks, contusions, and sprains. Body checks, sticks, and collisions with bodies and boards are all causes for many of these injuries.

Forearm, Wrist, and Hand Pain InjuryBones and Connective Tissue:• Ulna • Radius• Scaphoid- Fractured most• Flexor Retinaculum • Carpal Bones

Forearm, Wrist, and Hand Pain InjuryMuscles associated are: Extensor Carpi radialis longus Extensor Carpi Ulnaris Supinator Palmaris Longus muscle

Lower Back Pain InjuriesLower back pain is a common injury as the body is bent over and in constant motion, initiating or receiving body checks, rotating to generate power for a shot or pass, hit against boards or goal posts, or changing direction quickly. The lower back is susceptible to contusions and strains.

Lower Back MusclesMultifidus Iliopsoas Hamstrings AbdominalsErecorstinae Bones:• Lumbar region • 5 Vertebrae

Myofascial StretchingPatient is prone. Place thumb onto paraspinal muscles adjacent to the vertebral spinous process. In a bowing like motion stretch the muscles away from you and release. Perform slowly.

Lumbar rotation techniquePatient is supine. Have the patient lace fingers behind head. Standing to the side of the patient grab the patient’s contra lateral upper arm and pull toward you and caudally.

Lumbar MobilizationThe patient is in the lateral recumbent position. The side that the dysfunctional vertebra is rotated towards is up (eg, for a left rotated lumbar, the patient is lying on their RIGHT side). The patients upper most leg is dropped over the side of the table. The patients upper elbow is flexed. The lower elbow is also flexed and the arm is tucked under the head. Stand to the side of the patient with his/her face to you. Your one arm should be placed onto the upper elbow and the other arm placed on the upper hip. A twisting motion is performed by moving the patients elbow backward and the patient’s upper hip forwards, carrying the dysfunctional vertebra into correct position

Knee, Hip, Thigh, and Groin InjuryKnee, hip, thigh and Groin muscles are all known to be common injuries that can be sustained while participating in ice hockey. Knees frequently suffer from knee to knee contact and impact with boards at high speeds resulting in sprains or tears to the medial collateral and capsular ligaments. Hips thighs and groin are most susceptible to sprains, strains, and contusions.

Knee, Hip, Thigh, and Groin InjuryMuscles associated are:Adductor Magnus (Adductor Brevis and Adductor Longus) Gracilis Rectus Femoris Vastus Medialis Popliteus MuscleTibialis AnteriorGastrocnemius Muscle Bones Associated: •Femur •Tibia • Fibula

Varus strain

Valgus strain

Flexion of knee

Patellar Grind

Anterior Draw Test

Posterior draw test

Knee ballottement

McMurray test.

Apley compression test

Lachman test

Ideas for Ice Hockey Injury PreventionWeight TrainingWarm up and cool downs (dynamic warm-ups)Stretching and band exercises (Flexibility)Nutrition and appropriate rest

StretchingReaching lateral side stretchKneeling quad stretchKneeling heel-down Achilles stretch

Stretch oneGlide on the ice with your head and back straight. Slide your left leg back and point your skate away from the body. Bend the right knee and keep the left leg straight. Feel the stretch in the left groin area. Hold for at least 15 seconds and repeat on the other side.

Stretch twoHold a hockey stick while slowly skating forward. Raise the arms up and back with your palms up. This stretches the shoulders, upper back and arms.

Stretch threeLift your hockey stick above your head and tilt the top of your body to the right. Keep your feet apart. You should feel the stretch on your left side. Hold it for 10 seconds and then repeat on the opposite side.

Stretch fourSkate forward with your feet apart and bend forward at the hips. Keeping your knees bent, feel a stretch in the back of your legs. You should hold this stretch for at least 15 seconds.

Stretch fiveGrasp your hockey stick behind your back and glide forward. Slowly raise the stick up, keeping your arms straight. Hold for 15 seconds. You should feel this stretch in your upper arms.

Stretch sixLie flat on the ice with your feet together and knees apart. Lift your chest off of the ice with your arms and hold for at least 15 seconds. This should be felt in the lower back and the groin.Step 7

Stretch sevenSit on a stable surface with left leg bent and right leg crossed over it. Push against the right knee with the left elbow and rotate your body to the right. Turn the body by pushing the left arm and hand. Do not jerk or pull. Feel the stretch in your upper and lower back, as well as the hips and ribs.http://www.ehow.com/how_2047720_stretch-before-playing-hockey.html

Innervation TableOrgan/System Parasympathetic Sympathetic Ant. Chapman's Post. Chapman's EENT Cr Nerves (III, VII, IX, X) T1-T4 T1-4, 2 nd ICS Suboccipital Heart Vagus (CN X) T1-T4 T1-4 on L, T2-3 T3 sp process Respiratory Vagus (CN X) T2-T7 3 rd & 4 th ICS T3-5 sp process Esophagus Vagus (CN X) T2-T8 --- --- Foregut Vagus (CN X) T5-T9 (Greater Splanchnic) --- --- Stomach Vagus (CN X) T5-T9 (Greater Splanchnic) 5 th -6 th ICS on L T6-7 on L Liver Vagus (CN X) T5-T9 (Greater Splanchnic) Rib 5 on R T5-6 Gallbladder Vagus (CN X) T5-T9 (Greater Splanchnic) Rib 6 on R T6 Spleen Vagus (CN X) T5-T9 (Greater Splanchnic) Rib 7 on L T7 Pancreas Vagus (CN X) T5-T9 (Greater Splanchnic), T9-T12 (Lesser Splanchnic) Rib 7 on R T7 Midgut Vagus (CN X) Thoracic Splanchnics (Lesser) --- --- Small Intestine Vagus (CN X) T9-T11 (Lesser Splanchnic) Ribs 9-11 T8-10 Appendix    T12 Tip of 12 th Rib T11-12 on R Hindgut Pelvic Splanchnics (S2-4) Lumbar (Least) Splanchnics --- --- Ascending Colon  Vagus (CN X) T9-T11 (Lesser Splanchnic) R Femur @ hip T10-11 Transverse Colon  Vagus (CN X) T9-T11 (Lesser Splanchnic) Near Knees --- Descending Colon Pelvic Splanchnic (S2-4) Least Splanchnic L Femur @ hip T12-L2 Colon & Rectum Pelvic Splanchnics (S2-4) T8-L2 --- ---

Print out the answer sheet to use with the following questions.

Circle the correct answer and review with director:Question1: A, B, C, D, E.Question2: A, B, C, D, E.Question3: A, B, C, D, E.

Question 1In hockey injury to the leg caused by the leather of the skate is called: a. skate bite b. leather burn c. skate cut d. boot bolt e. lucky break

Question 2The most common separation injury is at which siteA. ac separationB. C1/C2C. Humoral tibialD. femoral hipE. L5 on sacrum

Question 3Tearing of the ulnar collateral ligament is called:A. gamekeeper’s thumbB. witlowC. hitch hikers thumbD slap thumbE. catch you later thumb

Congratulations