By Valerie FoutsFowler DO and Elliot Taxman American College of Osteopathic Pediatricians AT 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 t ID: 292834
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OMT Ice Hockey Module By Valerie Fouts-Fowler, DOand Elliot Taxman
American College of Osteopathic PediatriciansSlide2
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. Slide3
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. Slide4Slide5
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. Slide6
Common Ice Hockey InjuriesNeck and Spine Shoulders Knee, Hip, Thigh, and GroinForearm, Wrist, and Hand painLower BackSlide7
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 ligamentSlide8
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. Slide9
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 T1Slide10Slide11Slide12
RotationSlide13
SidebendingSlide14
Flexion and ExtensionSlide15
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.Slide16Slide17
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.Slide18Slide19
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. Slide20Slide21
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.Slide22Slide23
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.Slide24
BonesAssociated with the ShoulderBones Associated:ScapulaClavicle Humerus Slide25Slide26
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 Slide27Slide28
Ligament Associated:Rotator Cuff Axillary Nerve- can’t abduct -off of Brachial Plexus Slide29Slide30Slide31
The seven-step Spencer shoulder technique:Step 1—extension with elbow flexed; step 2—flexion with elbowextended; step 3—compression circumduction; step 4—circumduction
with 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 extendedSlide32
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. Slide33
Forearm, Wrist, and Hand Pain InjuryBones and Connective Tissue:• Ulna • Radius• Scaphoid- Fractured most• Flexor Retinaculum • Carpal BonesSlide34Slide35
Forearm, Wrist, and Hand Pain InjuryMuscles associated are: Extensor Carpi radialis longus Extensor Carpi Ulnaris Supinator Palmaris Longus muscle Slide36Slide37
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. Slide38
Lower Back MusclesMultifidus Iliopsoas Hamstrings AbdominalsErecorstinae
Bones:• Lumbar region
• 5 Vertebrae Slide39
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.Slide40Slide41
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.Slide42Slide43
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 positionSlide44Slide45
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. Slide46
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 Slide47Slide48
Varus strainSlide49
Valgus strainSlide50
Flexion of kneeSlide51
Patellar GrindSlide52
Anterior Draw TestSlide53
Posterior draw testSlide54
Knee ballottement Slide55
McMurray test. Slide56
Apley compression test Slide57
Lachman test Slide58
Ideas for Ice Hockey Injury PreventionWeight TrainingWarm up and cool downs (dynamic warm-ups)Stretching and band exercises (Flexibility)Nutrition and appropriate rest Slide59
StretchingReaching lateral side stretchKneeling quad stretchKneeling heel-down Achilles stretchSlide60
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.Slide61
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.Slide62
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.Slide63
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.Slide64
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.Slide65
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 7Slide66
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.htmlSlide67
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
---
---Slide68
Print out the answer sheet to use with the following questions.Slide69
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.Slide70
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 breakSlide71
Question 2The most common separation injury is at which siteA. ac separationB. C1/C2C. Humoral tibialD. femoral hipE. L5 on sacrumSlide72
Question 3Tearing of the ulnar collateral ligament is called:A. gamekeeper’s thumbB. witlowC. hitch hikers thumbD slap thumbE. catch you later thumbSlide73
Congratulations