OMT Ice Hockey Module By Valerie FoutsFowler DO

OMT Ice Hockey Module By Valerie Fouts-Fowler, DO and 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 Injury � � � � � Hockey 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 Injuries Neck and Spine Shoulders Knee, Hip, Thigh, and Groin Forearm, Wrist, and Hand pain Lower Back

Types of Ice Hockey Injuries Fractures, hands and wrist Sprains or Strains, • medial collateral • capsular ligaments of the knee Contusions, upper and lower body Separations, AC joint separation Skate bite, friction injury from leather of boot Concussions, mild to severe Lacerations, head, scalp and face Gamekeeper’s thumb • Tearing of the ulnar collateral ligament

Neck, Head and Spine Injuries Neck, 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 Injuries Muscles associated are: Sternohyoid muscle Sternocleidomastoid muscle Trapezius Splenius Capitis Splenius Cervicis Scalenus Medius Scalenus Posterior Levator Scapulae Multifidi (deep) Middle Semispinalis Capitis (Superficial) Rectus Capitus minor and major Oblliquus Capitis Inferior Bones • Cervical Vertebrae -C 3 responsible for diaphragm (Breathing) • Brachial Plexus injury -C 5 to T 1

Rotation

Sidebending

Flexion and Extension

Cradling and Traction The 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 Traction Place 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 Amplitude The 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.

3 rd to 7 th 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.

Bones. Associated with the Shoulder Bones Associated: Scapula Clavicle 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 elbow extended; step 3—compression circumduction; step 4—circumduction with traction with elbow extended; step 5 a—abduction with internal rotation with elbow flexed; Step 5 b- 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 Injury Forearms, 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 Injury Bones and Connective Tissue: • Ulna • Radius • Scaphoid- Fractured most • Flexor Retinaculum • Carpal Bones

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

Lower Back Pain Injuries Lower 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 Muscles Multifidus Iliopsoas Hamstrings Abdominals Erecorstinae Bones: • Lumbar region • 5 Vertebrae

Myofascial Stretching Patient 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 technique Patient 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 Mobilization The 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 Injury � Knee, 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 Injury Muscles associated are: Adductor Magnus (Adductor Brevis and Adductor Longus) Gracilis Bones Rectus Femoris Associated: Vastus Medialis • Femur Popliteus Muscle • Tibialis Anterior • Fibula Gastrocnemius Muscle

Varus strain

Valgus strain

Flexion of knee

Patellar Grind

Anterior Draw Test

Posterior draw test

Knee ballottement

Mc. Murray test.

Apley compression test

Lachman test

Ideas for Ice Hockey Injury Prevention Weight Training Warm up and cool downs (dynamic warmups) Stretching and band exercises (Flexibility) Nutrition and appropriate rest

Stretching Reaching lateral side stretch Kneeling quad stretch Kneeling heel-down Achilles stretch

Stretch one Glide 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 two Hold 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 three Lift 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 four Skate 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 five Grasp 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 six Lie 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 seven Sit 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 Table Organ/System EENT Parasympathetic Sympathetic Ant. Chapman's Post. Chapman's T 1 -T 4 T 1 -4, 2 nd ICS Suboccipital Heart Cr Nerves (III, VII, IX, X) Vagus (CN X) T 1 -T 4 T 3 sp process Respiratory Vagus (CN X) T 2 -T 7 T 1 -4 on L, T 23 rd 3 & 4 th ICS Esophagus Vagus (CN X) T 2 -T 8 --- T 3 -5 sp process --- Foregut Vagus (CN X) T 5 -T 9 (Greater Splanchnic) --- Stomach Vagus (CN X) T 5 -T 9 (Greater Splanchnic) T 6 -7 on L Liver Vagus (CN X) T 5 -T 9 (Greater Splanchnic) 5 th-6 th ICS on L Rib 5 on R Gallbladder Vagus (CN X) T 5 -T 9 (Greater Splanchnic) Rib 6 on R T 6 Spleen Vagus (CN X) T 5 -T 9 (Greater Splanchnic) Rib 7 on L T 7 Pancreas Vagus (CN X) Rib 7 on R T 7 Midgut Vagus (CN X) T 5 -T 9 (Greater Splanchnic), T 9 T 12 (Lesser Splanchnic) Thoracic Splanchnics (Lesser) Small Intestine Vagus (CN X) T 9 -T 11 (Lesser Splanchnic) Ribs 9 -11 T 8 -10 Appendix T 12 Tip of 12 th Rib T 11 -12 on R Hindgut Lumbar (Least) Splanchnics Ascending Colon Pelvic Splanchnics (S 24) Vagus (CN X) Transverse Colon Vagus (CN X) Descending Colon & Rectum T 9 -T 11 (Lesser Splanchnic) T 5 -6 --- --- --T 10 -11 T 9 -T 11 (Lesser Splanchnic) R Femur @ hip Near Knees Pelvic Splanchnic (S 2 -4) Least Splanchnic L Femur @ hip T 12 -L 2 Pelvic Splanchnics (S 24) T 8 -L 2 --- ---

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

Circle the correct answer and review with director: Question 1: A, B, C, D, E. Question 2: A, B, C, D, E. Question 3: A, B, C, D, E.

Question 1 In 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 2 The most common separation injury is at which site A. ac separation B. C 1/C 2 C. Humoral tibial D. femoral hip E. L 5 on sacrum

Question 3 Tearing of the ulnar collateral ligament is called: • A. gamekeeper’s thumb • B. witlow • C. hitch hikers thumb • D slap thumb • E. catch you later thumb

Congratulations